Provider Demographics
NPI:1033095427
Name:MARTINEZ, MARYSOL (PA-C)
Entity type:Individual
Prefix:
First Name:MARYSOL
Middle Name:
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 W ALEGRE DR
Mailing Address - Street 2:
Mailing Address - City:LITCHFIELD PARK
Mailing Address - State:AZ
Mailing Address - Zip Code:85340-4309
Mailing Address - Country:US
Mailing Address - Phone:786-326-5493
Mailing Address - Fax:
Practice Address - Street 1:315 W ALEGRE DR
Practice Address - Street 2:
Practice Address - City:LITCHFIELD PARK
Practice Address - State:AZ
Practice Address - Zip Code:85340-4309
Practice Address - Country:US
Practice Address - Phone:786-326-5493
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-12
Last Update Date:2025-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant