Healthcare Provider Details

I. General information

NPI: 1508171232
Provider Name (Legal Business Name): ANA LAURA MARTINEZ LMP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2010
Last Update Date: 06/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3180 W CLEARWATER AVE STE F
KENNEWICK WA
99336-2767
US

IV. Provider business mailing address

3180 W CLEARWATER AVE STE F
KENNEWICK WA
99336-2767
US

V. Phone/Fax

Practice location:
  • Phone: 509-783-6677
  • Fax:
Mailing address:
  • Phone: 509-783-6677
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA60059427
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: