Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080A0000X | Adolescent Medicine | 27189 | AZ |
N | 2080P0214X | Pediatric Pulmonologist | 27189 | AZ |
NPI | 1144252131 |
---|---|
Provider Name | Maria Martinez |
First Address | Phoenix, AZ 85020-4492 |
Second Address | Phoenix, AZ 85020-4492 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/07/2006 |
Last Update Date | 21/05/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
458738 | (05) | AZ |
F54149 | (02) | AZ |