Provider Demographics
NPI:1215531439
Name:MARTINEZ, GLORIA IBANIA (SA-C)
Entity type:Individual
Prefix:
First Name:GLORIA
Middle Name:IBANIA
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:SA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8231 SARDINA SHORE DR
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77433-2889
Mailing Address - Country:US
Mailing Address - Phone:281-919-9949
Mailing Address - Fax:
Practice Address - Street 1:710 CYPRESS CREEK PKWY
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77090-3402
Practice Address - Country:US
Practice Address - Phone:281-919-9949
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-29
Last Update Date:2020-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant