Healthcare Provider Details

I. General information

NPI: 1295849776
Provider Name (Legal Business Name): THERESA ANN MARTEZ ND, LMP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2006
Last Update Date: 01/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 CEDAR AVE SUITE 101
SNOHOMISH WA
98290
US

IV. Provider business mailing address

110 CEDAR AVE SUITE 101
SNOHOMISH WA
98290
US

V. Phone/Fax

Practice location:
  • Phone: 360-282-4014
  • Fax: 360-282-4017
Mailing address:
  • Phone: 360-282-4014
  • Fax: 360-282-4017

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code175F00000X
TaxonomyNaturopath
License NumberNT00001430
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License NumberNT1430
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: