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General NPI Number Information
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NPI Number | 1861651960
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Entity Type | Individual
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Provider Name | MIKE MARTINEZ PA
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Gender | Male
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Dates
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Enumeration Date | 06/03/2008
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Last Update Date | 04/02/2025
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Provider Practice Location Address
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Address Line | 7622 LOUIS PASTEUR DR STE 100
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City | SAN ANTONIO
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State | TX
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Zip | 78229-4019
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Country | US
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Telephone | 210-614-7840
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Fax | 210-562-2252
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Provider Business Mailing Address
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Address Line | 7622 LOUIS PASTEUR DR STE 100
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City | SAN ANTONIO
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State | TX
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Zip | 78229-4019
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Country | US
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Telephone | 210-614-7840
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Fax | 210-562-2252
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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 | PA01696
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License Number State | TX
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