MEDICARE: SAMANTHA 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	363A00000X	Physician Assistant	6996	AZ

General Provider Information

NPI Number	:	1891209268
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMANTHA MARTINEZ

Provider Business Mailing Address
First Line	:	8323 N SHANNON RD UNIT 19202
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85742-9799
Country	:	US
Telephone Number	:	432-770-5019
Fax Number	:

Provider Business Practice Location Address
First Line	:	7089 N THORNYDALE RD
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85741-2728
Country	:	US
Telephone Number	:	520-694-6600
Fax Number	:

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

Provider Enumeration Date	:	11/21/2017
Last Update Date	:	06/23/2021

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Directions to “ SAMANTHA MARTINEZ ” Practice Location

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