MEDICARE: MARTINEZ ANTUAN COATES

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	103TH0004X	Health Psychologist	2600245340	NV

General Provider Information

NPI Number	:	1396398947
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARTINEZ ANTUAN COATES

Provider Business Mailing Address
First Line	:	1755 PALM ST
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89104-4700
Country	:	US
Telephone Number	:	702-808-1846
Fax Number	:

Provider Business Practice Location Address
First Line	:	1755 PALM ST BLD T APT147
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89104
Country	:	UM
Telephone Number	:	702-808-1846
Fax Number	:

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

Provider Enumeration Date	:	07/23/2019
Last Update Date	:	07/23/2019

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Directions to “ MARTINEZ ANTUAN COATES ” Practice Location

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