Provider Demographics
NPI:1043846272
Name:MARTINEZ, DANIEL RAFAEL
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:RAFAEL
Last Name:MARTINEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:920 8TH ST
Mailing Address - Street 2:
Mailing Address - City:RAMONA
Mailing Address - State:CA
Mailing Address - Zip Code:92065-2812
Mailing Address - Country:US
Mailing Address - Phone:760-315-3019
Mailing Address - Fax:
Practice Address - Street 1:8825 AERO DR STE 305
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-2270
Practice Address - Country:US
Practice Address - Phone:858-378-2093
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-19
Last Update Date:2020-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator