Provider Demographics
NPI:1659195683
Name:MARTINEZ, BRIAN DEJESUS (PARAMEDIC, ATP)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:DEJESUS
Last Name:MARTINEZ
Suffix:
Gender:M
Credentials:PARAMEDIC, ATP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:BAS H&S 3D RECON BN
Mailing Address - Street 2:UNIT 36180
Mailing Address - City:FPO
Mailing Address - State:AP
Mailing Address - Zip Code:96389-6180
Mailing Address - Country:US
Mailing Address - Phone:219-256-2649
Mailing Address - Fax:
Practice Address - Street 1:BAS H&S 3D RECON BN
Practice Address - Street 2:UNIT 36180
Practice Address - City:FPO
Practice Address - State:AP
Practice Address - Zip Code:96389-6180
Practice Address - Country:US
Practice Address - Phone:219-256-2649
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-15
Last Update Date:2024-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC022479731710I1002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman