Individual
MARY KATHRYN MARTINEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1801 HOLLYWOOD DR, PUEBLO, CO 81005-2511
(719) 242-6612
Mailing address
251 BONNYMEDE RD, PUEBLO, CO 81001-1333
(575) 491-1353
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
AT.0001957
CO
390200000X
Student in an Organized Health Care Education/Training Program
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Other
Enumeration date
09/13/2017
Last updated
04/08/2020
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