Provider Demographics
NPI:1144252131
Name:MARTINEZ, MARIA (MD)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7720 N 16TH ST
Mailing Address - Street 2:STE 425
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85020-4492
Mailing Address - Country:US
Mailing Address - Phone:602-476-0800
Mailing Address - Fax:602-476-0801
Practice Address - Street 1:7720 N 16TH ST
Practice Address - Street 2:STE 425
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85020-4492
Practice Address - Country:US
Practice Address - Phone:602-476-0800
Practice Address - Fax:602-476-0801
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2012-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ271892080P0214X, 2080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
No2080P0214XAllopathic & Osteopathic PhysiciansPediatricsPediatric Pulmonology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ458738Medicaid
AZ458738Medicaid