Basic Information
| Provider Information | |||||||||
| NPI: | 1720407422 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MARTIN | ||||||||
| FirstName: | ASHLEY | ||||||||
| MiddleName: | Y | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3016 W CHARLESTON BLVD | ||||||||
| Address2: | STE 100 | ||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891021973 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7022180915 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1707 W CHARLESTON BLVD STE 160 | ||||||||
| Address2: | |||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891022354 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7026715150 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/09/2014 | ||||||||
| LastUpdateDate: | 01/04/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/04/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | DO2554 | NV | Y | Allopathic & Osteopathic Physicians | Surgery | 208600000X | 0102204639 | VA | N | Allopathic & Osteopathic Physicians | Surgery |
No ID Information.