Provider Demographics
NPI:1013231158
Name:MARTINEZ-BRENERS, VICTOR (CMT)
Entity Type:Individual
Prefix:MR
First Name:VICTOR
Middle Name:
Last Name:MARTINEZ-BRENERS
Suffix:
Gender:M
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 W FALLBROOK AVE
Mailing Address - Street 2:STE 105
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93711-5833
Mailing Address - Country:US
Mailing Address - Phone:559-647-5307
Mailing Address - Fax:
Practice Address - Street 1:401 W FALLBROOK AVE
Practice Address - Street 2:STE 105
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93711-5833
Practice Address - Country:US
Practice Address - Phone:559-647-5307
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-18
Last Update Date:2010-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAM51225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAM51OtherMASSAGE THERAPY LICENSE