Provider Demographics
NPI:1043985518
Name:MARTINEZ, LETICIA
Entity Type:Individual
Prefix:
First Name:LETICIA
Middle Name:
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:516 GIBSON DR STE 100
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95678-5792
Mailing Address - Country:US
Mailing Address - Phone:916-724-5056
Mailing Address - Fax:916-724-2685
Practice Address - Street 1:124 MAIN ST
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95678-2232
Practice Address - Country:US
Practice Address - Phone:916-774-6802
Practice Address - Fax:916-724-2685
Is Sole Proprietor?:No
Enumeration Date:2021-08-16
Last Update Date:2023-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker