1184265563 NPI number — DR. ALFREDO VELASCO MARTINEZ DDS

Table of content: DR. ALFREDO VELASCO MARTINEZ DDS (NPI 1184265563)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184265563 NPI number — DR. ALFREDO VELASCO MARTINEZ DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MARTINEZ
Provider First Name:
ALFREDO
Provider Middle Name:
VELASCO
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DDS
Provider Gender Code:
M

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:
1184265563
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/12/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
COMMANDING OFFICER
Provider Second Line Business Mailing Address:
2D DENBN/NDC, PSC 20130 315 MCHUGH BLVD
Provider Business Mailing Address City Name:
CAMP LEJEUNE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28542-0130
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
910-451-2208
Provider Business Mailing Address Fax Number:
910-451-8479

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3445 HENDERSON DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JACKSONVILLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28546-5233
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-347-1283
Provider Business Practice Location Address Fax Number:
910-347-2153
Provider Enumeration Date:
10/07/2019

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: 1223G0001X , with the licence number:  13316 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 122300000X , with the licence number: 104078 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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