Provider Demographics
NPI:1063176303
Name:MARTINEZ, DAVID MALAQUIAS (NURSE PRACTITIONER)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:MALAQUIAS
Last Name:MARTINEZ
Suffix:
Gender:M
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1204 E CAMELIA AVE
Mailing Address - Street 2:
Mailing Address - City:HIDALGO
Mailing Address - State:TX
Mailing Address - Zip Code:78557-2658
Mailing Address - Country:US
Mailing Address - Phone:956-778-6110
Mailing Address - Fax:
Practice Address - Street 1:2800 W TRENTON RD
Practice Address - Street 2:STE 2868
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78539-7853
Practice Address - Country:US
Practice Address - Phone:281-888-8999
Practice Address - Fax:281-305-4054
Is Sole Proprietor?:No
Enumeration Date:2021-10-22
Last Update Date:2021-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1054872363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily