Provider Demographics
NPI:1215684386
Name:MARTINEZ HERNANDEZ, MIGUEL ANGEL (EMT-P)
Entity type:Individual
Prefix:
First Name:MIGUEL
Middle Name:ANGEL
Last Name:MARTINEZ HERNANDEZ
Suffix:
Gender:M
Credentials:EMT-P
Other - Prefix:
Other - First Name:MIGUEL
Other - Middle Name:ANGEL
Other - Last Name:MARTINEZ HERNANDEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:EMT-P
Mailing Address - Street 1:536 SKYLARK LN LOT 23
Mailing Address - Street 2:
Mailing Address - City:LINWOOD
Mailing Address - State:NC
Mailing Address - Zip Code:27299-8919
Mailing Address - Country:US
Mailing Address - Phone:704-431-7226
Mailing Address - Fax:
Practice Address - Street 1:207 OLD LEXINGTON RD
Practice Address - Street 2:
Practice Address - City:THOMASVILLE
Practice Address - State:NC
Practice Address - Zip Code:27360-3428
Practice Address - Country:US
Practice Address - Phone:336-472-2000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-08
Last Update Date:2022-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP124530146L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146L00000XEmergency Medical Service ProvidersEmergency Medical Technician, Paramedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
YPS103167865OtherBLUE CROSS BLUE SHIELD