MEDICARE: ILIUVA RAMIREZ MARTINEZ APRN-CNP

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	363LF0000X	Family Nurse Practitioner	1006384	TX

General Provider Information

NPI Number	:	1851161806
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ILIUVA RAMIREZ MARTINEZ APRN-CNP

Provider Business Mailing Address
First Line	:	4455 THORNTON ST APT 325
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76106-2536
Country	:	US
Telephone Number	:	512-201-5858
Fax Number	:

Provider Business Practice Location Address
First Line	:	9751 WALNUT ST STE 100
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75243-2345
Country	:	US
Telephone Number	:	469-730-3130
Fax Number	:	469-730-3154

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

Provider Enumeration Date	:	01/02/2024
Last Update Date	:	01/02/2024

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