Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | MT9397 | NM |
NPI | 1013522861 |
---|---|
Provider Name | Elizandro Martinez |
First Address | Santa Fe, NM 87507 |
Second Address | Santa Fe, NM 87505-4786 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/09/2020 |
Last Update Date | 24/09/2020 |