Shidestini Martinez
Student in an Organized Health Care Education/Training Program in Shreveport, LA. Individual provider (NPI-1).
NPI number1801465331
StatusActive
Last updated in NPPESJun 19, 2021
Details
- NPI
- 1801465331
- Entity type
- Individual (NPI-1)
- Name
- Shidestini Martinez
- Sex
- Female
- Sole proprietor
- Yes
- Enumeration date
- Jun 19, 2021
- Certification date
- Jun 19, 2021
- Last updated
- Jun 19, 2021
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 390200000X | Student in an Organized Health Care Education/Training Program | – | – | Yes |
Practice location
1501 Kings HwyShreveport, LA 71103-4228
Phone 318-626-0434
Mailing address
1501 Kings HwyShreveport, LA 71103-4228
Phone 318-626-0434
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