Provider Demographics
NPI:1386860542
Name:MARTINEZ, ROBERT JR (FNP)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:MARTINEZ
Suffix:JR
Gender:
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 JACKIE RD SE STE 106
Mailing Address - Street 2:
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87124-1518
Mailing Address - Country:US
Mailing Address - Phone:505-934-1071
Mailing Address - Fax:
Practice Address - Street 1:1400 JACKIE RD SE STE 106
Practice Address - Street 2:
Practice Address - City:RIO RANCHO
Practice Address - State:NM
Practice Address - Zip Code:87124-1518
Practice Address - Country:US
Practice Address - Phone:505-934-1071
Practice Address - Fax:505-451-0054
Is Sole Proprietor?:No
Enumeration Date:2007-04-17
Last Update Date:2025-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX607676363LF0000X
NMCNP-02939363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily