Basic Information
| Provider Information | |||||||||
| NPI: | 1518131960 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MARTINEZ | ||||||||
| FirstName: | MILAGROS | ||||||||
| MiddleName: | ANAHI | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 16620 N US HIGHWAY 281 STE 300 | ||||||||
| Address2: | |||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782322679 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2106141231 | ||||||||
| FaxNumber: | 2104990811 | ||||||||
| Practice Location | |||||||||
| Address1: | 11481 TOEPPERWEIN RD STE 1202 | ||||||||
| Address2: | |||||||||
| City: | LIVE OAK | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782333146 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2106558470 | ||||||||
| FaxNumber: | 2109670276 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/16/2008 | ||||||||
| LastUpdateDate: | 10/25/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/25/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RN0300X | P7667 | TX | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology |
ID Information
| ID | Type | State | Issuer | Description | 331944404 | 05 | TX | MEDICAID | 331944405 | 01 | TX | CSHCN | OTHER |