Individual
MODESTO ALONZO MARTINEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
14203 BUSINESS AVE, LAREDO, TX 78045-7909
(956) 744-1264
Mailing address
14203 BUSINESS AVE, LAREDO, TX 78045-7909
(956) 744-1264
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11650142
TEXAS DL
TX
Enumeration date
05/20/2022
Last updated
05/20/2022
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