Samuel Martinez
Individual provider Active NPI Community Health Worker · Moroni, UT
NPI 1043687742 · NPPES record last updated Aug 28, 2015
Key facts
- NPI
- 1043687742
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Community Health Worker 172V00000X
- Practice address
- 21260 N. 1450 E.
Moroni, UT 84646-0383 - Phone
- (435) 445-3575
- NPI assigned
- Aug 28, 2015
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community Health Worker | 172V00000X | Yes |
Addresses
Primary practice location
21260 N. 1450 E.
Moroni, UT 84646-0383
Mailing address
21260 N. 1450 E.
Moroni, UT 84646-0383
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1 | Medicaid | UT |
Other providers in Moroni, UT
- Lighthouse Academy LLC
- Lighthouse Ranch
- Lighthouse Ranch LLC
- Keith Livingston
- McKade Lusk
- Nathan Miner
- Greg Morley
- Donald Moroney
- Michael Moroney
- Richard Newton
All providers in Moroni, UT · Community Health Worker in Utah
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 28, 2015. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.