Basic Information
| Provider Information | |||||||||
| NPI: | 1376165894 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MARTINEZ SANTORI | ||||||||
| FirstName: | MARA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1133 JOHN FREEMAN BOULEVARD | ||||||||
| Address2: | JJL 285A | ||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 77030 | ||||||||
| CountryCode: | US | ||||||||
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| FaxNumber: | 7134860699 | ||||||||
| Practice Location | |||||||||
| Address1: | 1133 JOHN FREEMAN BLVD | ||||||||
| Address2: | JJL 285A | ||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 77030 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7135004472 | ||||||||
| FaxNumber: | 7134860966 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/07/2020 | ||||||||
| LastUpdateDate: | 04/14/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 04/14/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.