Provider Demographics
NPI:1427638519
Name:MARTINEZ, NELDA NAE
Entity type:Individual
Prefix:
First Name:NELDA
Middle Name:NAE
Last Name:MARTINEZ
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 1:613 S EXPRESSWAY 83
Mailing Address - Street 2:
Mailing Address - City:HARLINGEN
Mailing Address - State:TX
Mailing Address - Zip Code:78550-5905
Mailing Address - Country:US
Mailing Address - Phone:956-428-9647
Mailing Address - Fax:
Practice Address - Street 1:613 S EXPRESSWAY 83
Practice Address - Street 2:
Practice Address - City:HARLINGEN
Practice Address - State:TX
Practice Address - Zip Code:78550-5905
Practice Address - Country:US
Practice Address - Phone:956-428-9647
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-12
Last Update Date:2021-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX277413183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician