Provider Demographics
NPI:1942754155
Name:MARTINEZ, JESUS GABRIEL (OD)
Entity type:Individual
Prefix:
First Name:JESUS
Middle Name:GABRIEL
Last Name:MARTINEZ
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3515 SAINT ROSE PKWY STE 110
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-4596
Mailing Address - Country:US
Mailing Address - Phone:702-848-3387
Mailing Address - Fax:702-848-3778
Practice Address - Street 1:3515 SAINT ROSE PKWY STE 110
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-4596
Practice Address - Country:US
Practice Address - Phone:702-848-3387
Practice Address - Fax:702-848-3778
Is Sole Proprietor?:No
Enumeration Date:2016-08-05
Last Update Date:2021-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV1010152W00000X
CA33634-TLG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist