Individual
MISS MARIAH MAUREEN MARTINEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1421 MONTANA VISTA ST, ESPANOLA, NM 87532
(505) 929-0123
Mailing address
PO BOX 1141, ESPANOLA, NM 87532-1141
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
502695304
NM
Other
Enumeration date
08/28/2016
Last updated
04/05/2017
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