Provider Demographics
NPI:1770151490
Name:MARTINEZ, ANTONIA MARIA (RN)
Entity type:Individual
Prefix:
First Name:ANTONIA
Middle Name:MARIA
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P O BOX 310001-0670
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:NM
Mailing Address - Zip Code:87571-1094
Mailing Address - Country:US
Mailing Address - Phone:505-758-6966
Mailing Address - Fax:575-751-5214
Practice Address - Street 1:1090 GOAT SPRINGS ROAD
Practice Address - Street 2:
Practice Address - City:TAOS
Practice Address - State:NM
Practice Address - Zip Code:87571-1094
Practice Address - Country:US
Practice Address - Phone:575-758-6966
Practice Address - Fax:575-751-5214
Is Sole Proprietor?:No
Enumeration Date:2021-06-17
Last Update Date:2021-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMRN-83225163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse