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General NPI Number Information
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NPI Number | 1659895365
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Entity Type | Individual
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Provider Name | BO ANTHONY MARTINEZ AUD
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Gender | Male
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Dates
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Enumeration Date | 08/03/2017
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Last Update Date | 10/06/2024
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Provider Practice Location Address
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Address Line | 5505 N MESA ST STE 3
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City | EL PASO
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State | TX
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Zip | 79912-5464
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Country | US
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Telephone | 915-234-2454
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Fax |
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Provider Business Mailing Address
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Address Line | 2001 CALLE DE NINOS
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City | LAS CRUCES
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State | NM
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Zip | 88005-3298
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Country | US
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Telephone | 719-924-3805
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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 | 231H00000X
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Taxonomy Name | Audiologist
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License Number | 80998
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License Number State | TX
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