MEDICARE: MR. JAVIER MARTINEZ LSA

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	363AS0400X	Surgical Physician Assistant	SA00413	TX

General Provider Information

NPI Number	:	1942524251
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JAVIER MARTINEZ LSA

Provider Business Mailing Address
First Line	:	7250 LIBERTY MESA LN
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77049-3996
Country	:	US
Telephone Number	:	281-691-0844
Fax Number	:

Provider Business Practice Location Address
First Line	:	7250 LIBERTY MESA LN
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77049-3996
Country	:	US
Telephone Number	:	281-691-0844
Fax Number	:

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

Provider Enumeration Date	:	03/16/2010
Last Update Date	:	01/22/2024

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