Individual
MR. EDIN MARTINEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
5425 N 80TH LN, GLENDALE, AZ 85303-5517
(623) 872-9122
Mailing address
5425 N 80TH LN, GLENDALE, AZ 85303-5517
(623) 872-9122
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
9305
AZ
Other
Enumeration date
06/08/2007
Last updated
08/07/2007
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