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General NPI Number Information
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NPI Number | 1417589003
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Entity Type | Individual
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Provider Name | RAQUEL Q MARTINEZ PA-C
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Gender | Female
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Dates
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Enumeration Date | 02/11/2020
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Last Update Date | 08/12/2020
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Provider Practice Location Address
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Address Line | 10615 JEFFREYS ST
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City | HENDERSON
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State | NV
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Zip | 89052-4194
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Country | US
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Telephone | 702-463-4788
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Fax |
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Provider Business Mailing Address
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Address Line | 1000 AMERICAN PACIFIC DR APT 2113
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City | HENDERSON
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State | NV
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Zip | 89074-8017
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Country | US
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Telephone | 702-858-1357
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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