1164924015 NPI number — SOLEDAD CAROLINA MARTINEZ-PATEL MOT, OTR

Table of content: SOLEDAD CAROLINA MARTINEZ-PATEL MOT, OTR (NPI 1164924015)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164924015 NPI number — SOLEDAD CAROLINA MARTINEZ-PATEL MOT, OTR

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MARTINEZ-PATEL
Provider First Name:
SOLEDAD
Provider Middle Name:
CAROLINA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MOT, OTR
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:
1164924015
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/07/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
305 NE LOOP 820; BUSINESS TOWER 1,
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
HURST
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76053
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
817-292-8787
Provider Business Mailing Address Fax Number:
817-789-6849

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
17480 DALLAS PKWY STE 221
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DALLAS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75287-7361
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
469-291-8500
Provider Business Practice Location Address Fax Number:
866-341-4918
Provider Enumeration Date:
03/07/2018

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: 225XP0200X , with the licence number:  114770 , 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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