Healthcare Provider Details

I. General information

NPI: 1588255681
Provider Name (Legal Business Name): ASHLYNN MARIE MARTINEZ PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/01/2021
Last Update Date: 02/28/2023
Certification Date: 02/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10433 S REDWOOD RD
SOUTH JORDAN UT
84095-8502
US

IV. Provider business mailing address

10433 S REDWOOD RD
SOUTH JORDAN UT
84095-8502
US

V. Phone/Fax

Practice location:
  • Phone: 801-501-0500
  • Fax:
Mailing address:
  • Phone: 801-501-0500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number11898533-1206
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number11898533-1206
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: