MEDICARE: MS. MARIA ANITA MARTINEZ R.PH., CDE

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	1835P1200X	Pharmacotherapy Pharmacist	24025	TX

General Provider Information

NPI Number	:	1417179433
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARIA ANITA MARTINEZ R.PH., CDE

Provider Business Mailing Address
First Line	:	2819 BURNING HILL
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78247-3805
Country	:	US
Telephone Number	:	210-827-4449
Fax Number	:

Provider Business Practice Location Address
First Line	:	2819 BURNING HILL
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78247-3805
Country	:	US
Telephone Number	:	210-827-4449
Fax Number	:

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

Provider Enumeration Date	:	05/02/2007
Last Update Date	:	07/08/2007

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