Individual
REBECCA L MARTINEZ GONZALEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
100 BREWSTER BLVD, CAMP LEJEUNE, NC 28547-2575
(910) 450-3902
Mailing address
803 CANVAS CT, SWANSBORO, NC 28584-8844
(252) 764-5464
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
0000000910
TN
363AS0400X
Surgical Physician Assistant
Primary
0010-05853
NC
363AS0400X
Surgical Physician Assistant
0110001067
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1356307664
OPTIMA HEALTH PLAN
VA
01
—
540506332108
TRICARE/CHAMPUS
VA
01
—
P01041461
RAILROAD MEDICARE
VA
Enumeration date
04/25/2006
Last updated
09/24/2025
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