MEDICARE: MRS. JULIE ANN MARTINEZ LMP

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	174400000X	Specialist	MA21412	WA

General Provider Information

NPI Number	:	1275598534
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JULIE ANN MARTINEZ LMP

Provider Business Mailing Address
First Line	:	PO BOX 1425
Second Line	:
City	:	SULTAN
State	:	WA
Zip	:	98294-1425
Country	:	US
Telephone Number	:	360-794-6729
Fax Number	:

Provider Business Practice Location Address
First Line	:	311 W STEVENS AVE
Second Line	:
City	:	SULTAN
State	:	WA
Zip	:	98294-9466
Country	:	US
Telephone Number	:	360-793-1122
Fax Number	:

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

Provider Enumeration Date	:	04/19/2006
Last Update Date	:	07/08/2007

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