Provider Demographics
NPI:1679886303
Name:JUAN J MARTINEZ
Entity type:Organization
Organization Name:JUAN J MARTINEZ
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-905-0600
Mailing Address - Street 1:1401 W POLK AVE
Mailing Address - Street 2:SUITE F
Mailing Address - City:PHARR
Mailing Address - State:TX
Mailing Address - Zip Code:78577-2444
Mailing Address - Country:US
Mailing Address - Phone:956-905-0600
Mailing Address - Fax:
Practice Address - Street 1:1401 W POLK AVE
Practice Address - Street 2:SUITE F
Practice Address - City:PHARR
Practice Address - State:TX
Practice Address - Zip Code:78577-2444
Practice Address - Country:US
Practice Address - Phone:956-905-0600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-22
Last Update Date:2010-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXRVS00069021261QR0208X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0208XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mobile