Healthcare Provider Details

I. General information

NPI: 1801223102
Provider Name (Legal Business Name): CHARLES ULICK MARTINEZ CRNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/01/2013
Last Update Date: 10/10/2025
Certification Date: 10/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8316 ARLINGTON BLVD STE 420
FAIRFAX VA
22031-5216
US

IV. Provider business mailing address

8316 ARLINGTON BLVD STE 420
FAIRFAX VA
22031-5216
US

V. Phone/Fax

Practice location:
  • Phone: 703-520-9703
  • Fax: 703-520-9703
Mailing address:
  • Phone: 703-520-9703
  • Fax: 703-563-9602

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024173453
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: