Basic Information
| Provider Information | |||||||||
| NPI: | 1790438422 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MARTINEZ | ||||||||
| FirstName: | KARLA | ||||||||
| MiddleName: | MINETTE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4600 S ULSTER ST STE 1225 | ||||||||
| Address2: | |||||||||
| City: | DENVER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802372696 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7202873093 | ||||||||
| FaxNumber: | 7202873195 | ||||||||
| Practice Location | |||||||||
| Address1: | 4600 S ULSTER ST STE 1225 | ||||||||
| Address2: | |||||||||
| City: | DENVER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802372696 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7202873093 | ||||||||
| FaxNumber: | 7202873195 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/02/2022 | ||||||||
| LastUpdateDate: | 02/02/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 02/02/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 246ZE0600X | 3500 | Y | Technologists, Technicians & Other Technical Service Providers | Specialist/Technologist, Other | Electroneurodiagnostic |
No ID Information.