Provider Demographics
NPI:1366936569
Name:MARTINEZ-MENENDEZ, CARLOS JULIAN
Entity type:Individual
Prefix:
First Name:CARLOS JULIAN
Middle Name:
Last Name:MARTINEZ-MENENDEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 531968
Mailing Address - Street 2:
Mailing Address - City:HARLINGEN
Mailing Address - State:TX
Mailing Address - Zip Code:78553-1968
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:956-296-6842
Practice Address - Street 1:2902 HAINE DR
Practice Address - Street 2:
Practice Address - City:HARLINGEN
Practice Address - State:TX
Practice Address - Zip Code:78550
Practice Address - Country:US
Practice Address - Phone:956-296-4000
Practice Address - Fax:956-296-2842
Is Sole Proprietor?:No
Enumeration Date:2018-06-20
Last Update Date:2024-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXU80932084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXBP1-0063562OtherTEXAS MEDICAL BOARD
TXU8093OtherTEXAS MEDICAL BOARD