MEDICARE: JUAN CARLOS MARTINEZ-MORENO MD PC

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	332900000X	Non-Pharmacy Dispensing Site		NV
2	208100000X	Physical Medicine & Rehabilitation Physician		NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1962808303
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JUAN CARLOS MARTINEZ-MORENO MD PC

Provider Business Mailing Address
First Line	:	3017 W CHARLESTON BLVD
Second Line	:	SUITE 90
City	:	LAS VEGAS
State	:	NV
Zip	:	89102-1941
Country	:	US
Telephone Number	:	702-826-2816
Fax Number	:	702-826-2813

Provider Business Practice Location Address
First Line	:	3017 W CHARLESTON BLVD
Second Line	:	SUITE 90
City	:	LAS VEGAS
State	:	NV
Zip	:	89102-1941
Country	:	US
Telephone Number	:	702-826-2816
Fax Number	:	702-826-2813

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JUAN CARLOS MARTINEZ-MORENO
Credential	:	M.D.
Telephone Number	:	702-826-2816

Provider Enumeration Date	:	11/12/2014
Last Update Date	:	06/11/2015

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