Provider Demographics
NPI:1053742353
Name:STRANGE, MARTEL
Entity type:Individual
Prefix:
First Name:MARTEL
Middle Name:
Last Name:STRANGE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:247 RUSTIC CLUB WAY
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89148-5202
Mailing Address - Country:US
Mailing Address - Phone:760-333-6497
Mailing Address - Fax:
Practice Address - Street 1:3920 W ANN RD
Practice Address - Street 2:SUITE 100
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89031-3839
Practice Address - Country:US
Practice Address - Phone:760-333-6497
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-12-11
Last Update Date:2013-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor