Provider Demographics
NPI:1124608591
Name:MARTINEZ, RYAN MARK (CRNA)
Entity type:Individual
Prefix:MR
First Name:RYAN
Middle Name:MARK
Last Name:MARTINEZ
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10905 W 103RD CT
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CO
Mailing Address - Zip Code:80021-7812
Mailing Address - Country:US
Mailing Address - Phone:775-843-0227
Mailing Address - Fax:
Practice Address - Street 1:8000 E MAPLEWOOD AVE STE 200
Practice Address - Street 2:
Practice Address - City:GREENWOOD VILLAGE
Practice Address - State:CO
Practice Address - Zip Code:80111-4727
Practice Address - Country:US
Practice Address - Phone:303-785-4700
Practice Address - Fax:720-439-9500
Is Sole Proprietor?:No
Enumeration Date:2021-04-10
Last Update Date:2024-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CORN.1627576163W00000X
COAPN.0996899-CRNA367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse