Provider Demographics
NPI:1962144600
Name:MARTINEZ, BRENDAN ANDREW
Entity type:Individual
Prefix:
First Name:BRENDAN
Middle Name:ANDREW
Last Name:MARTINEZ
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 1:3614 S LISBON ST
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80013-6644
Mailing Address - Country:US
Mailing Address - Phone:720-600-2547
Mailing Address - Fax:
Practice Address - Street 1:3614 S LISBON ST
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80013-6644
Practice Address - Country:US
Practice Address - Phone:720-600-2547
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-12
Last Update Date:2022-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health