Provider Demographics
NPI:1548551591
Name:MARTINEZ, JUAN J
Entity type:Individual
Prefix:MR
First Name:JUAN
Middle Name:J
Last Name:MARTINEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 N 10TH ST 340 A
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78501-2680
Mailing Address - Country:US
Mailing Address - Phone:956-905-0600
Mailing Address - Fax:
Practice Address - Street 1:1300 N 10TH ST 340 A
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78501-2680
Practice Address - Country:US
Practice Address - Phone:956-905-0600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-26
Last Update Date:2011-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXRVS00069021247100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247100000XTechnologists, Technicians & Other Technical Service ProvidersRadiologic Technologist