Individual
LA TISHA MARTINEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
3825 EUBANK BLVD NE STE A, ALBUQUERQUE, NM 87111-3590
(052) 928-5755
(505) 292-8409
Mailing address
5900 CANYON VISTA DR NE, ALBUQUERQUE, NM 87111-6621
(505) 400-0693
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
79563
NM
Other
Enumeration date
06/22/2024
Last updated
03/10/2025
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