=====================================================
General NPI Number Information
=====================================================
NPI Number | 1669271466
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | GISELLE MARTINEZ
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/12/2025
-----------------------------------------------------
Last Update Date | 03/12/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 899 N LOGAN ST STE 407
-----------------------------------------------------
City | DENVER
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80203-3155
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-284-8674
-----------------------------------------------------
Fax | 888-710-3082
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 899 N LOGAN ST STE 407
-----------------------------------------------------
City | DENVER
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80203-3155
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-284-8674
-----------------------------------------------------
Fax | 888-710-3082
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 374700000X
-----------------------------------------------------
Taxonomy Name | Technician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 3747P1801X
-----------------------------------------------------
Taxonomy Name | Personal Care Attendant
-----------------------------------------------------
License Number | NA.00823983
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 246Z00000X
-----------------------------------------------------
Taxonomy Name | Other Specialist/Technologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------