Basic Information
| Provider Information | |||||||||
| NPI: | 1730619545 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MARTINEZ-MORALES | ||||||||
| FirstName: | SAMUEL | ||||||||
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| Credential: | CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 301 W BRITTON RD UNIT 13618 | ||||||||
| Address2: | |||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731134787 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4057153610 | ||||||||
| FaxNumber: | 4057153612 | ||||||||
| Practice Location | |||||||||
| Address1: | 9600 BROADWAY EXT | ||||||||
| Address2: | |||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731147408 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4057153610 | ||||||||
| FaxNumber: | 4057153612 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/14/2017 | ||||||||
| LastUpdateDate: | 06/14/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | 120325 | OK | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
No ID Information.