1477278307 NPI number — MARTE A MARTINEZ MD PLLC

Table of content: (NPI 1477278307)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477278307 NPI number — MARTE A MARTINEZ MD PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MARTE A MARTINEZ MD PLLC
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:
1477278307
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/10/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 450708
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAREDO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78045-0017
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
956-795-8393
Provider Business Mailing Address Fax Number:
956-795-8396

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2637 CORNERSTONE BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EDINBURG
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78539-8436
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
956-631-9041
Provider Business Practice Location Address Fax Number:
956-664-2416
Provider Enumeration Date:
10/04/2022

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MARTINEZ
Authorized Official First Name:
MARTE
Authorized Official Middle Name:
AQUILES
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
956-795-8393

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208VP0014X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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