MEDICARE: MARISOL 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	374U00000X	Home Health Aide

General Provider Information

NPI Number	:	1871117713
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARISOL MARTINEZ

Provider Business Mailing Address
First Line	:	2300 HARVARD WAY
Second Line	:
City	:	RENO
State	:	NV
Zip	:	89502-4002
Country	:	US
Telephone Number	:	775-219-4662
Fax Number	:

Provider Business Practice Location Address
First Line	:	2300 HARVARD WAY APT 113B
Second Line	:
City	:	RENO
State	:	NV
Zip	:	89502-4023
Country	:	US
Telephone Number	:	775-219-4662
Fax Number	:

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

Provider Enumeration Date	:	06/06/2020
Last Update Date	:	06/06/2020

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Directions to “ MARISOL MARTINEZ ” Practice Location

Language	Start Address	Practice Location

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