Healthcare Provider Details

I. General information

NPI: 1306603667
Provider Name (Legal Business Name): MARIA A. MARTINEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/04/2024
Last Update Date: 03/04/2024
Certification Date: 03/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1408 E 8TH ST
WESLACO TX
78596-6639
US

IV. Provider business mailing address

1721 BOBCAT LN
HARLINGEN TX
78550-8732
US

V. Phone/Fax

Practice location:
  • Phone: 956-968-0103
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1148950
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: