Provider Demographics
NPI:1023363892
Name:MARTINEZ, SAMANTHA JANE (HS)
Entity Type:Individual
Prefix:MRS
First Name:SAMANTHA
Middle Name:JANE
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:HS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 EDIZ HOOK
Mailing Address - Street 2:USCG SFO CLINIC
Mailing Address - City:PORT ANGELES
Mailing Address - State:WA
Mailing Address - Zip Code:98362-2201
Mailing Address - Country:US
Mailing Address - Phone:360-417-5894
Mailing Address - Fax:360-417-5899
Practice Address - Street 1:1 EDIZ HOOK
Practice Address - Street 2:USCG SFO CLINIC
Practice Address - City:PORT ANGELES
Practice Address - State:WA
Practice Address - Zip Code:98362-2201
Practice Address - Country:US
Practice Address - Phone:360-417-5894
Practice Address - Fax:360-417-5899
Is Sole Proprietor?:No
Enumeration Date:2012-07-18
Last Update Date:2012-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAB1978078146N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic