MEDICARE: MS. TAMARA ROSE MARTINEZ LMT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171W00000X	Contractor	LMT 5402	NM

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	LMT5402	OTHER	NM	MASSAGE THERAPIST

General Provider Information

NPI Number	:	1013122290
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. TAMARA ROSE MARTINEZ LMT

Provider Business Mailing Address
First Line	:	1413 GLORIETA ST NE
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87112-4118
Country	:	US
Telephone Number	:	505-610-2612
Fax Number	:

Provider Business Practice Location Address
First Line	:	8005 PENNSYLVANIA CIR NE
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87110-7810
Country	:	US
Telephone Number	:	505-248-0798
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/11/2007
Last Update Date	:	07/08/2007

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