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General NPI Number Information
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NPI Number | 1356307664
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Entity Type | Individual
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Provider Name | REBECCA L MARTINEZ GONZALEZ PA-C
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Gender | Female
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Dates
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Enumeration Date | 04/25/2006
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Last Update Date | 09/24/2025
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Provider Practice Location Address
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Address Line | 100 BREWSTER BLVD
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City | CAMP LEJEUNE
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State | NC
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Zip | 28547-2575
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Country | US
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Telephone | 910-450-3902
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Fax |
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Provider Business Mailing Address
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Address Line | 803 CANVAS CT
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City | SWANSBORO
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State | NC
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Zip | 28584-8844
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Country | US
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Telephone | 252-764-5464
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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 | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | 0010-05853
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | 0000000910
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License Number State | TN
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Taxonomy #3
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | 0110001067
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License Number State | VA
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