Provider Demographics
NPI:1215313069
Name:MARTINEZ, MAYRA O (PA)
Entity type:Individual
Prefix:
First Name:MAYRA
Middle Name:O
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:MAYRA
Other - Middle Name:OFELIA
Other - Last Name:MARTINEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PA
Mailing Address - Street 1:PO BOX 117
Mailing Address - Street 2:
Mailing Address - City:ROMA
Mailing Address - State:TX
Mailing Address - Zip Code:78584-0117
Mailing Address - Country:US
Mailing Address - Phone:956-607-7250
Mailing Address - Fax:
Practice Address - Street 1:2768 PHARMACY RD
Practice Address - Street 2:
Practice Address - City:RIO GRANDE CITY
Practice Address - State:TX
Practice Address - Zip Code:78582-6201
Practice Address - Country:US
Practice Address - Phone:956-487-5621
Practice Address - Fax:956-487-5862
Is Sole Proprietor?:No
Enumeration Date:2015-08-04
Last Update Date:2022-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA09800363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant