Provider Demographics
NPI:1316170798
Name:MARTINEZ-FLEN, DWAN B
Entity type:Individual
Prefix:
First Name:DWAN
Middle Name:B
Last Name:MARTINEZ-FLEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 E EARLL DR
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85012-2634
Mailing Address - Country:US
Mailing Address - Phone:575-742-2620
Mailing Address - Fax:575-742-3182
Practice Address - Street 1:121 TOWNSGATE PLZ
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:NM
Practice Address - Zip Code:88101-3714
Practice Address - Country:US
Practice Address - Phone:575-742-2620
Practice Address - Fax:575-742-3182
Is Sole Proprietor?:No
Enumeration Date:2009-09-01
Last Update Date:2014-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator