Provider Demographics
NPI:1861736290
Name:MARTINEZ, JUANITA DIANE
Entity type:Individual
Prefix:MRS
First Name:JUANITA
Middle Name:DIANE
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 W MAIN ST STE A2
Mailing Address - Street 2:
Mailing Address - City:ARTESIA
Mailing Address - State:NM
Mailing Address - Zip Code:88210-3711
Mailing Address - Country:US
Mailing Address - Phone:575-746-8890
Mailing Address - Fax:
Practice Address - Street 1:1700 W MAIN ST STE A2
Practice Address - Street 2:
Practice Address - City:ARTESIA
Practice Address - State:NM
Practice Address - Zip Code:88210-3711
Practice Address - Country:US
Practice Address - Phone:575-746-8890
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-26
Last Update Date:2012-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator