Basic Information
| Provider Information | |||||||||
| NPI: | 1477629368 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MARTINEZ | ||||||||
| FirstName: | JOSEPH | ||||||||
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| Credential: | CSFA | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 76510 | ||||||||
| Address2: | |||||||||
| City: | COLORADO SPRINGS | ||||||||
| State: | CO | ||||||||
| PostalCode: | 809706510 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7196388844 | ||||||||
| FaxNumber: | 7196388115 | ||||||||
| Practice Location | |||||||||
| Address1: | 1322 N ACADEMY BLVD STE 204 | ||||||||
| Address2: | |||||||||
| City: | COLORADO SPRINGS | ||||||||
| State: | CO | ||||||||
| PostalCode: | 809093320 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7193311578 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/24/2006 | ||||||||
| LastUpdateDate: | 08/04/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 246ZC0007X | 93907 | CO | Y | Technologists, Technicians & Other Technical Service Providers | Specialist/Technologist, Other | Certified First Assistant |
No ID Information.