Provider Demographics
NPI:1588975718
Name:MARTINEZ, JULISSA
Entity type:Individual
Prefix:
First Name:JULISSA
Middle Name:
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 1:700 EXTERIOR ST
Mailing Address - Street 2:2ND
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10451-2042
Mailing Address - Country:US
Mailing Address - Phone:718-665-9230
Mailing Address - Fax:171-866-5923
Practice Address - Street 1:700 EXTERIOR ST
Practice Address - Street 2:2ND
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10451-2042
Practice Address - Country:US
Practice Address - Phone:718-665-9230
Practice Address - Fax:171-866-5923
Is Sole Proprietor?:No
Enumeration Date:2010-06-22
Last Update Date:2010-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYNY152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist