Basic Information
| Provider Information | |||||||||
| NPI: | 1730623125 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MARTINEZ | ||||||||
| FirstName: | EVELYN | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1000 | ||||||||
| Address2: | KCMH | ||||||||
| City: | BAKERSFIELD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 933021000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6618686601 | ||||||||
| FaxNumber: | 6618611020 | ||||||||
| Practice Location | |||||||||
| Address1: | 2525 N CHESTER AVE | ||||||||
| Address2: | |||||||||
| City: | BAKERSFIELD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 933081770 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8009915272 | ||||||||
| FaxNumber: | 6618681839 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/05/2016 | ||||||||
| LastUpdateDate: | 02/09/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | 3451392 | CA | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.