MEDICARE: JOHN LEE MARTINEZ HIS

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	237700000X	Hearing Instrument Specialist	0790	NM

General Provider Information

NPI Number	:	1992020184
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN LEE MARTINEZ HIS

Provider Business Mailing Address
First Line	:	5203 JUAN TABO BLVD NE STE 1F
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87111-2683
Country	:	US
Telephone Number	:	505-323-7373
Fax Number	:	505-323-2668

Provider Business Practice Location Address
First Line	:	5109 COORS BLVD NW STE D
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87120-1925
Country	:	US
Telephone Number	:	505-890-7373
Fax Number	:	505-890-8621

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

Provider Enumeration Date	:	03/31/2010
Last Update Date	:	05/20/2011

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