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General NPI Number Information
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NPI Number | 1629700869
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Entity Type | Individual
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Provider Name | MARCO A MARTINEZ PA
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Gender | Male
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Dates
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Enumeration Date | 06/27/2022
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Last Update Date | 05/05/2025
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Provider Practice Location Address
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Address Line | 306 E MAIN AVE STE 6
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City | ALTON
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State | TX
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Zip | 78573-6955
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Country | US
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Telephone | 956-597-3005
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Fax | 855-576-4965
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Provider Business Mailing Address
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Address Line | 2107 JOY ST
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City | EDINBURG
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State | TX
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Zip | 78539-6061
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Country | US
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Telephone | 956-975-8401
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA17042
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA17042
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License Number State | TX
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