Individual
JUSTIN ANGELO MARTINEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1100 LEAD AVE, ALBUQUERQUE, NM 87106-5215
(505) 224-7292
Mailing address
PO BOX 26666, PROVIDER ENROLLMENT, ALBUQUERQUE, NM 87125-6666
(505) 923-6770
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA2020-0114
NM
363AM0700X
Medical Physician Assistant
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Other
Enumeration date
12/03/2020
Last updated
04/27/2021
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