Individual
MARIO P MARTINEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NP
Contact information
Practice address
1115 12TH AVE RD, NAMPA, ID 83686-5738
(208) 498-1080
Mailing address
10482 W CARLTON BAY DR, GARDEN CITY, ID 83714-5143
(208) 955-6500
(208) 955-6501
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
NP-817A
ID
363L00000X
Nurse Practitioner
NP817A
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
80705880
—
ID
05
—
807746300
—
ID
Enumeration date
05/22/2007
Last updated
07/07/2026
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