Individual
MRS. CELESTE LISA MARTINEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA04566
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PA04566
STATE LICENSE NUMBER
TX
01
—
S0148059
DPS
TX
Enumeration date
09/26/2006
Last updated
10/28/2009
Update your record
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