MEDICARE: MS. LOURDES MARTINEZ M.AC L.AC

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	171100000X	Acupuncturist	U01923	MD

General Provider Information

NPI Number	:	1295012128
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LOURDES MARTINEZ M.AC L.AC

Provider Business Mailing Address
First Line	:	2931 OLNEY SANDY SPRING RD
Second Line	:	SUITE F
City	:	OLNEY
State	:	MD
Zip	:	20832-1527
Country	:	US
Telephone Number	:	301-774-0332
Fax Number	:	301-710-0614

Provider Business Practice Location Address
First Line	:	2931 OLNEY SANDY SPRING RD
Second Line	:	SUITE F
City	:	OLNEY
State	:	MD
Zip	:	20832-1527
Country	:	US
Telephone Number	:	301-774-0332
Fax Number	:	301-710-0614

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

Provider Enumeration Date	:	11/06/2011
Last Update Date	:	11/06/2011

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