Provider Demographics
NPI:1093136624
Name:MARTINEZ, TIMOTHY ANDREW (PA-C)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:ANDREW
Last Name:MARTINEZ
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 31630
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85751-1630
Mailing Address - Country:US
Mailing Address - Phone:520-784-6200
Mailing Address - Fax:520-784-6109
Practice Address - Street 1:6320 N LA CHOLLA BLVD STE 200
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85741-3549
Practice Address - Country:US
Practice Address - Phone:520-784-6200
Practice Address - Fax:520-784-6109
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-28
Last Update Date:2024-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5559363A00000X, 363AS0400X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical