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General NPI Number Information
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NPI Number | 1649987975
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Entity Type | Individual
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Provider Name | ILEANA LIZETH MARTINEZ NP
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Gender | Female
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Dates
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Enumeration Date | 11/07/2022
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Last Update Date | 07/14/2025
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Provider Practice Location Address
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Address Line | 108A N MAIN ST
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City | DAYTON
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State | TX
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Zip | 77535-2642
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Country | US
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Telephone | 281-440-5300
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Fax |
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Provider Business Mailing Address
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Address Line | 2255 E MOSSY OAKS RD STE 500
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City | SPRING
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State | TX
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Zip | 77389-1813
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Country | US
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Telephone | 832-597-4570
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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 | 163WM0705X
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Taxonomy Name | Medical-Surgical Registered Nurse
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License Number | 946931
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 1110885
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License Number State | TX
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