Provider Demographics
NPI:1023193430
Name:MARTINEZ, EVANGELINA E (MD)
Entity Type:Individual
Prefix:
First Name:EVANGELINA
Middle Name:E
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 UPPER RAGSDALE DR STE B200
Mailing Address - Street 2:
Mailing Address - City:MONTEREY
Mailing Address - State:CA
Mailing Address - Zip Code:93940-7844
Mailing Address - Country:US
Mailing Address - Phone:831-375-6334
Mailing Address - Fax:831-375-6331
Practice Address - Street 1:2 UPPER RAGSDALE DR STE B200
Practice Address - Street 2:
Practice Address - City:MONTEREY
Practice Address - State:CA
Practice Address - Zip Code:93940-7844
Practice Address - Country:US
Practice Address - Phone:831-375-6334
Practice Address - Fax:831-375-6331
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2019-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG54793207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE91288Medicare UPIN