MEDICARE: DR. JUAN CARLOS MARTINEZ-MORENO M.D.

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	208100000X	Physical Medicine & Rehabilitation Physician	16826	PR

General Provider Information

NPI Number	:	1114118676
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JUAN CARLOS MARTINEZ-MORENO M.D.

Provider Business Mailing Address
First Line	:	3017 W CHARLESTON BLVD
Second Line	:	SUITE 90
City	:	LAS VEGAS
State	:	NV
Zip	:	89102-1941
Country	:	US
Telephone Number	:	702-826-2816
Fax Number	:	702-826-2813

Provider Business Practice Location Address
First Line	:	3017 W CHARLESTON BLVD
Second Line	:	SUITE 90
City	:	LAS VEGAS
State	:	NV
Zip	:	89102-1941
Country	:	US
Telephone Number	:	702-826-2816
Fax Number	:	702-826-2813

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

Provider Enumeration Date	:	08/08/2007
Last Update Date	:	06/03/2015

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Practice Fax: 702-826-2813

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