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General NPI Number Information
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NPI Number | 1295311603
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Entity Type | Individual
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Provider Name | CAROLINE MARTINEZ LAT, ATC
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Gender | Female
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Dates
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Enumeration Date | 03/24/2021
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Last Update Date | 03/24/2021
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Provider Practice Location Address
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Address Line | 730 8TH AVE SW
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City | VALLEY CITY
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State | ND
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Zip | 58072
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Country | US
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Telephone | 602-332-7166
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Fax |
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Provider Business Mailing Address
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Address Line | 258 WINTER SHOW RD SE APT 213
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City | VALLEY CITY
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State | ND
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Zip | 58072-4050
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Country | US
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Telephone |
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Fax |
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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 | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number |
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License Number State |
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