Provider Demographics
NPI:1225525017
Name:MARTINEZ, KENDRA KELLY (MD, IBCLC)
Entity type:Individual
Prefix:DR
First Name:KENDRA
Middle Name:KELLY
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:MD, IBCLC
Other - Prefix:
Other - First Name:KENDRA
Other - Middle Name:MARIE
Other - Last Name:KELLY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6621 FANNIN ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-2358
Mailing Address - Country:US
Mailing Address - Phone:832-826-1380
Mailing Address - Fax:832-825-2799
Practice Address - Street 1:6621 FANNIN ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-2358
Practice Address - Country:US
Practice Address - Phone:832-826-1380
Practice Address - Fax:832-825-2799
Is Sole Proprietor?:No
Enumeration Date:2018-04-17
Last Update Date:2024-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN69028208000000X
TXU2261208000000X
NC308091208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics