1700888781 NPI number — LUIS & TERESA MARTINEZ, INC.

Table of content: (NPI 1700888781)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700888781 NPI number — LUIS & TERESA MARTINEZ, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LUIS & TERESA MARTINEZ, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
MEDCENTER PHARMACY
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1700888781
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1419 E BUSTAMANTE ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAREDO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78041-5303
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
956-791-1991
Provider Business Mailing Address Fax Number:
956-791-6279

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1419 E BUSTAMANTE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAREDO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78041-5303
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
956-791-1991
Provider Business Practice Location Address Fax Number:
956-791-6279
Provider Enumeration Date:
08/10/2005

Additional Information

Authorized Official

Authorized Official Last Name:
MARTINEZ
Authorized Official First Name:
LUIS
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
956-791-1991

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  23883 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 30109 . This is a "PHARMACIST LICENSE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 145491 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: P0139036 . This is a "DPS NO." identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 4598299 . This is a "NABP" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 014351302 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 014351301 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 23883 . This is a "PHARMACY LICENSE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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