MEDICARE: YADIRA MARTINEZ

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	3747P1801X	Personal Care Attendant

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	F5055074	OTHER	CA	DRIVERS LICENSE

General Provider Information

NPI Number	:	1720614142
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YADIRA MARTINEZ

Provider Business Mailing Address
First Line	:	2131 WEBSTER ST
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89030-6648
Country	:	US
Telephone Number	:	909-470-4987
Fax Number	:

Provider Business Practice Location Address
First Line	:	2131 WEBSTER ST
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89030-6648
Country	:	US
Telephone Number	:	909-470-4987
Fax Number	:

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

Provider Enumeration Date	:	03/17/2020
Last Update Date	:	03/17/2020

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Directions to “ YADIRA MARTINEZ ” Practice Location

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