Individual
MS. KIMBERLY J MARTINEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
6606 LBJ FWY STE 200, DALLAS, TX 75240-6524
(972) 715-5000
(972) 715-9976
Mailing address
PO BOX 650865, DALLAS, TX 75265-0865
(972) 715-5000
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
580963
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
166058102
—
TX
05
—
166058104
—
TX
05
—
166058106
—
TX
01
—
85453U
BCBS
TX
01
—
8854UG
BCBS TX
TX
01
—
P00428313
RAILROAD MEDICARE
TX
Enumeration date
12/29/2005
Last updated
10/30/2015
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