1033493010 NPI number — DINORAH MARTINEZ-ANDERSON FNP-C

Table of content: DINORAH MARTINEZ-ANDERSON FNP-C (NPI 1033493010)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033493010 NPI number — DINORAH MARTINEZ-ANDERSON FNP-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MARTINEZ-ANDERSON
Provider First Name:
DINORAH
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
FNP-C
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:
1033493010
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/25/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1555 UNIVERSITY BLVD
Provider Second Line Business Mailing Address:
TEXAS STATE UNIVERSITY STUDENT HEALTH CENTER
Provider Business Mailing Address City Name:
ROUND ROCK
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78665
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
512-245-2161
Provider Business Mailing Address Fax Number:
512-245-9260

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1001 E UNIVERSITY AVE
Provider Second Line Business Practice Location Address:
SOUTHWESTERN UNIVERSITY HEALTH SERVICES
Provider Business Practice Location Address City Name:
GEORGETOWN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78626-6100
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
512-863-1252
Provider Business Practice Location Address Fax Number:
512-863-1814
Provider Enumeration Date:
10/07/2011

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: 363LF0000X , with the licence number:  601522 , 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)





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