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Individual

JEREMY MARTINEZ

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man

Contact information

Practice address
208 GUACHUPANGUE RD, ESPANOLA, NM 87532
(505) 852-3865
Mailing address
PO BOX 3935, ESPANOLA, NM 87533
(505) 852-3865

Taxonomy

Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
LPN-22091
NM

Other

Enumeration date
02/04/2015
Last updated
02/04/2015
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