Provider Demographics
NPI:1104058494
Name:MARTINEZ, ELIZABETH S (LMT)
Entity type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:S
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 77 BOX 271
Mailing Address - Street 2:
Mailing Address - City:LAGUNA
Mailing Address - State:NM
Mailing Address - Zip Code:87026-9704
Mailing Address - Country:US
Mailing Address - Phone:505-918-6270
Mailing Address - Fax:
Practice Address - Street 1:HC 77 BOX 271
Practice Address - Street 2:
Practice Address - City:LAGUNA
Practice Address - State:NM
Practice Address - Zip Code:87026-9704
Practice Address - Country:US
Practice Address - Phone:505-918-6270
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-20
Last Update Date:2009-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM4067174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist