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General NPI Number Information
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NPI Number | 1497224448
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Entity Type | Individual
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Provider Name | LAQUINTA MARTIN
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Gender | Female
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Dates
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Enumeration Date | 11/20/2018
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Last Update Date | 11/20/2018
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Provider Practice Location Address
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Address Line | 930 BROOKDALE ST
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City | MARTINSVILLE
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State | VA
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Zip | 24112-3105
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Country | US
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Telephone | 276-732-4852
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Fax | 276-632-9456
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Provider Business Mailing Address
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Address Line | PO BOX 3324
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City | MARTINSVILLE
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State | VA
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Zip | 24115-3324
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Country | US
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Telephone | 276-732-4852
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Fax | 276-632-9456
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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 | 302F00000X
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Taxonomy Name | Exclusive Provider Organization
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License Number |
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License Number State |
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