1912913658 NPI number — DR. CARLA A MARTINEZ M.D.

Table of content: DOROTHY B TREVINO PHD (NPI 1588722722)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912913658 NPI number — DR. CARLA A MARTINEZ M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MARTINEZ
Provider First Name:
CARLA
Provider Middle Name:
A
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

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:
1912913658
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/12/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
440 RAYNOLDS ST # 51015
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EL PASO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
79905-1613
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
915-215-4480
Provider Business Mailing Address Fax Number:
915-215-5386

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4801 ALBERTA AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EL PASO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79905-2707
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
915-215-5000
Provider Business Practice Location Address Fax Number:
915-215-8662
Provider Enumeration Date:
08/01/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X , with the licence number:  MD2012-0852 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207V00000X , with the licence number: M3635 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207VM0101X , with the licence number: MD2012-0852 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207VM0101X , with the licence number: M3635 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 267233YNB8 . This is a "NEW MEXICO MEDICARE PTN" identifier , issued by the state of ( NM ) . This identifiers is of the category "OTHER".
  • Identifier: 183331101 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8A4439 . This is a "BCBSTX" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 8G7647 . This is a "MEDICARE ID TYPE UNSPEC" identifier , issued by the state of ( NM ) . This identifiers is of the category "OTHER".
  • Identifier: 02855879 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".




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