Individual
DOMINIQUE EBONIECE MARTINEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
FNP-BC
Contact information
Practice address
6414 MYRTLE AVE, GLENDALE, NY 11385-6203
(718) 805-0037
(866) 221-0879
Mailing address
PO BOX 211226, WOODHAVEN, NY 11421-6226
(917) 932-7378
(866) 221-0879
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
2023006023
CA
363LF0000X
Family Nurse Practitioner
Primary
355973
NY
363LF0000X
Family Nurse Practitioner
NP95026260
CA
Other
Enumeration date
06/20/2023
Last updated
03/04/2026
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