Provider Demographics
NPI:1861185209
Name:MARTINEZ, BRANDON (AA)
Entity type:Individual
Prefix:
First Name:BRANDON
Middle Name:
Last Name:MARTINEZ
Suffix:
Gender:M
Credentials:AA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5413 LA ESTANCIA CIR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79932-2011
Mailing Address - Country:US
Mailing Address - Phone:915-261-4917
Mailing Address - Fax:
Practice Address - Street 1:5413 LA ESTANCIA CIR
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79932-2011
Practice Address - Country:US
Practice Address - Phone:915-261-4917
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-31
Last Update Date:2023-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367H00000XPhysician Assistants & Advanced Practice Nursing ProvidersAnesthesiologist Assistant