Basic Information
| Provider Information | |||||||||
| NPI: | 1952617813 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MARTINEZ | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 201 N K ST | ||||||||
| Address2: | |||||||||
| City: | TULARE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 932744005 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5592560100 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 201 N K ST | ||||||||
| Address2: | |||||||||
| City: | TULARE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 932744005 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5592560100 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/29/2010 | ||||||||
| LastUpdateDate: | 09/01/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | SOCIAL WORK STUDENT | CA | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.