MEDICARE: MR. LUIS RAFAEL MARTINEZ

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	310400000X	Assisted Living Facility	312552	TX

General Provider Information

NPI Number	:	1043194384
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. LUIS RAFAEL MARTINEZ

Provider Business Mailing Address
First Line	:	301 S GLENWOOD ST
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79905-5218
Country	:	US
Telephone Number	:	915-294-7316
Fax Number	:

Provider Business Practice Location Address
First Line	:	301 S GLENWOOD ST
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79905-5218
Country	:	US
Telephone Number	:	915-294-7316
Fax Number	:

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

Provider Enumeration Date	:	07/31/2025
Last Update Date	:	07/31/2025

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