Provider Demographics
NPI:1366982613
Name:MARTINEZ GUZMAN, JESUS (CNA)
Entity type:Individual
Prefix:
First Name:JESUS
Middle Name:
Last Name:MARTINEZ GUZMAN
Suffix:
Gender:M
Credentials:CNA
Other - Prefix:
Other - First Name:JESUS
Other - Middle Name:OCTAVIO
Other - Last Name:MARTINEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CNA
Mailing Address - Street 1:1663 MARION BENNET DR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89106-2462
Mailing Address - Country:US
Mailing Address - Phone:702-982-9589
Mailing Address - Fax:
Practice Address - Street 1:2780 S JONES BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146-5628
Practice Address - Country:US
Practice Address - Phone:702-323-1323
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-06
Last Update Date:2017-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner