1689344111 NPI number — AZALIA MARTINEZ II, M.D.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689344111 NPI number — AZALIA MARTINEZ II, M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AZALIA MARTINEZ II, M.D.
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:
Provider Other Organization Name Type Code:
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:
1689344111
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/16/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
24165 IH 10 W STE 217
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN ANTONIO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78257-1160
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
210-660-8883
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
LAUREL RIDGE TREATMENT CENTER
Provider Second Line Business Practice Location Address:
17720 CORPORATE WOODS DRIVE
Provider Business Practice Location Address City Name:
SAN ANTONIO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78259
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-491-9400
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/16/2021

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MARTINEZ
Authorized Official First Name:
AZALIA
Authorized Official Middle Name:
Authorized Official Title or Position:
MEDICAL DOCTOR
Authorized Official Telephone Number:
915-637-5541

Provider Taxonomy Codes

  • Taxonomy code: 2084P0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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