Provider Demographics
NPI:1194528703
Name:MARTIN, IMELDA
Entity type:Individual
Prefix:MS
First Name:IMELDA
Middle Name:
Last Name:MARTIN
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:855 E TWAIN AVE STE 105
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89169-0820
Mailing Address - Country:US
Mailing Address - Phone:702-937-0790
Mailing Address - Fax:
Practice Address - Street 1:855 E TWAIN AVE STE 105
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89169-0820
Practice Address - Country:US
Practice Address - Phone:702-937-0790
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-29
Last Update Date:2025-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374700000XNursing Service Related ProvidersTechnician