Basic Information
| Provider Information | |||||||||
| NPI: | 1609270461 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MARTINEZ | ||||||||
| FirstName: | EILEEN FRANCES | ||||||||
| MiddleName: | AGUON | ||||||||
| NamePrefix: | MS. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3270 N VANCOUVER AVE APT 320 | ||||||||
| Address2: | |||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972272040 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6573219152 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1507 NE 122ND AVE | ||||||||
| Address2: | |||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972301911 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9712762185 | ||||||||
| FaxNumber: | 3105761027 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/22/2014 | ||||||||
| LastUpdateDate: | 06/04/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/04/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 171M00000X | N | Other Service Providers | Case Manager/Care Coordinator | 1041C0700X | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.