Provider Demographics
NPI:1073203212
Name:MARTINEZ, ADILENE
Entity Type:Individual
Prefix:
First Name:ADILENE
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 1:777 E 3RD ST APT D301
Mailing Address - Street 2:
Mailing Address - City:POMONA
Mailing Address - State:CA
Mailing Address - Zip Code:91766-2018
Mailing Address - Country:US
Mailing Address - Phone:831-261-2942
Mailing Address - Fax:
Practice Address - Street 1:777 E 3RD ST APT D301
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91766-2018
Practice Address - Country:US
Practice Address - Phone:831-261-2942
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-10
Last Update Date:2023-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program