Provider Demographics
NPI:1215901004
Name:MARTINEZ, LYNORE MARGARET (MD)
Entity type:Individual
Prefix:DR
First Name:LYNORE
Middle Name:MARGARET
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 KIVA CT
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-5879
Mailing Address - Country:US
Mailing Address - Phone:505-988-4922
Mailing Address - Fax:505-988-4924
Practice Address - Street 1:405 KIVA CT
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-5879
Practice Address - Country:US
Practice Address - Phone:505-988-4922
Practice Address - Fax:505-988-4924
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-16
Last Update Date:2011-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM95294207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM58375OtherPRESBYTERIAN
NM00068674Medicaid
NMNM009T01OtherBLUE CROSS
NMNM009T01OtherBLUE CROSS
NM58375OtherPRESBYTERIAN