Individual
MR. JUAN MARTINEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
602 SW 38TH ST, LAWTON, OK 73505-6912
(580) 248-5780
Mailing address
4510 SW MALCOM RD, LAWTON, OK 73505-8053
(580) 713-1497
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200786490A
—
OK
Enumeration date
08/03/2018
Last updated
02/27/2019
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