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General NPI Number Information
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NPI Number | 1013663111
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Entity Type | Individual
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Provider Name | JUSTIN ANTHONY MARTINEZ PA
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Gender | Male
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Dates
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Enumeration Date | 02/28/2022
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Last Update Date | 03/04/2025
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Provider Practice Location Address
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Address Line | 717 ENCINO PL NE STE 12
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City | ALBUQUERQUE
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State | NM
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Zip | 87102-2638
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Country | US
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Telephone | 866-606-3867
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Fax |
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Provider Business Mailing Address
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Address Line | 101 HOSPITAL LOOP NE STE 209
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City | ALBUQUERQUE
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State | NM
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Zip | 87109-2128
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Country | US
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Telephone | 505-848-3773
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Fax | 505-848-3741
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA0009075
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA2022-0121
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License Number State | NM
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