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General NPI Number Information
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NPI Number | 1225227754
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Entity Type | Organization
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Legal Business Name | LYNORE M MARTINEZ MD PROFESSIONAL ASSOCIATION
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Dates
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Enumeration Date | 10/22/2007
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Last Update Date | 12/21/2007
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Provider Practice Location Address
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Address Line | 405 KIVA CT
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City | SANTA FE
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State | NM
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Zip | 87505
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Country | US
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Telephone | 505-988-4922
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Fax | 505-988-4924
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Provider Business Mailing Address
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Address Line | 405 KIVA CT
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City | SANTA FE
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State | NM
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Zip | 87505
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Country | US
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Telephone | 505-988-4922
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Fax | 505-988-4924
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Authorized Official
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Title or Position | OWNER
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Name | DR. LYNORE M MARTINEZ
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Credential | MD
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Telephone | 505-988-4922
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 95294
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License Number State | NM
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