Provider Demographics
NPI:1033255922
Name:MARTINEZ, WILFREDO (PA)
Entity Type:Individual
Prefix:
First Name:WILFREDO
Middle Name:
Last Name:MARTINEZ
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6291 ACELA CT
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92506-3787
Mailing Address - Country:US
Mailing Address - Phone:951-273-1188
Mailing Address - Fax:951-346-3107
Practice Address - Street 1:5430 ARLINGTON AVE
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92504-2505
Practice Address - Country:US
Practice Address - Phone:951-689-2955
Practice Address - Fax:951-689-2477
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2008-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA13532363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant