Basic Information
Provider Information
NPI: 1124427232
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MARTINEZ
FirstName: ARELI
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: FNP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 305 E CENTER AVE
Address2:  
City: VISALIA
State: CA
PostalCode: 932916331
CountryCode: US
TelephoneNumber: 5597374700
FaxNumber: 5597341247
Practice Location
Address1: 1107 W POPLAR AVE
Address2:  
City: PORTERVILLE
State: CA
PostalCode: 932575839
CountryCode: US
TelephoneNumber: 5597817242
FaxNumber: 5597933574
Other Information
ProviderEnumerationDate: 08/14/2014
LastUpdateDate: 08/14/2014
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LF0000X95000634CAY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily

No ID Information.


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