MEDICARE: YAIMA MARTINEZ GONZALEZ NP

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	363L00000X	Nurse Practitioner	1109289	TX

General Provider Information

NPI Number	:	1760198964
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YAIMA MARTINEZ GONZALEZ NP

Provider Business Mailing Address
First Line	:	3935 BANKS LANDING CT
Second Line	:
City	:	FULSHEAR
State	:	TX
Zip	:	77441-4553
Country	:	US
Telephone Number	:	281-661-1079
Fax Number	:

Provider Business Practice Location Address
First Line	:	3935 BANKS LANDING CT
Second Line	:
City	:	FULSHEAR
State	:	TX
Zip	:	77441-4553
Country	:	US
Telephone Number	:	281-661-1079
Fax Number	:

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

Provider Enumeration Date	:	01/31/2023
Last Update Date	:	06/12/2023

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