Individual
JERRY MARTINEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
COTA
Contact information
Practice address
921 E MAIN AVE STE 5, ALTON, TX 78573-1606
(956) 519-2500
Mailing address
921 E MAIN AVE STE 5, ALTON, TX 78573-1606
(956) 519-2500
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
209135
TX
Other
Enumeration date
07/21/2016
Last updated
07/21/2016
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