Basic Information
| Provider Information | |||||||||
| NPI: | 1497961718 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MARTINEZ-JIMENEZ | ||||||||
| FirstName: | TANIA | ||||||||
| MiddleName: | CONSUELO | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1107 EATON AVE | ||||||||
| Address2: | |||||||||
| City: | BETHLEHEM | ||||||||
| State: | PA | ||||||||
| PostalCode: | 180181862 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4845262400 | ||||||||
| FaxNumber: | 4845263697 | ||||||||
| Practice Location | |||||||||
| Address1: | 1107 EATON AVE | ||||||||
| Address2: | |||||||||
| City: | BETHLEHEM | ||||||||
| State: | PA | ||||||||
| PostalCode: | 180181862 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4845262400 | ||||||||
| FaxNumber: | 4845263697 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/15/2007 | ||||||||
| LastUpdateDate: | 05/30/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | MD432480 | PA | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
ID Information
| ID | Type | State | Issuer | Description | 1001275120017 | 05 | PA | MEDICAID |