=====================================================
General NPI Number Information
=====================================================
NPI Number | 1528532223
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | GARIELLE KARA MARTINEZ NP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/15/2019
-----------------------------------------------------
Last Update Date | 01/15/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5741 S FORT APACHE RD STE 120
-----------------------------------------------------
City | LAS VEGAS
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89148-5622
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 702-798-0111
-----------------------------------------------------
Fax | 844-247-3481
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5130 S FORT APACHE RD # 215-232
-----------------------------------------------------
City | LAS VEGAS
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89148-1719
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 702-798-0111
-----------------------------------------------------
Fax | 844-247-3481
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208VP0000X
-----------------------------------------------------
Taxonomy Name | Pain Medicine Physician
-----------------------------------------------------
License Number | 817436
-----------------------------------------------------
License Number State | NV
-----------------------------------------------------