Healthcare Provider Details

I. General information

NPI: 1396491304
Provider Name (Legal Business Name): ALEXANDRIA MARTIN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2022
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 N MARIO CAPECCHI DR
SALT LAKE CITY UT
84108
US

IV. Provider business mailing address

30 N MARIO CAPECCHI DR
SALT LAKE CITY UT
84108
US

V. Phone/Fax

Practice location:
  • Phone: 801-587-7572
  • Fax:
Mailing address:
  • Phone: 801-587-7572
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License Number14286740-1205
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35967
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: