Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156F00000X | Technician/Technologist | 249893 | TX |
NPI | 1265052963 |
---|---|
Provider Name | Alfredo Martinez |
First Address | Dallas, TX 75211-5003 |
Second Address | Dallas, TX 75235-7709 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/04/2020 |
Last Update Date | 22/04/2020 |