Provider Demographics
NPI:1083836019
Name:MARTINEZ, OFELIA (PROSTHESIS FITTER)
Entity Type:Individual
Prefix:MS
First Name:OFELIA
Middle Name:
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:PROSTHESIS FITTER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2503 CALLE QUEBRADA
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92139-2306
Mailing Address - Country:US
Mailing Address - Phone:619-470-1938
Mailing Address - Fax:619-294-3436
Practice Address - Street 1:2515 CAMINO DEL RIO S
Practice Address - Street 2:SUITE 242A
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-3792
Practice Address - Country:US
Practice Address - Phone:619-294-3436
Practice Address - Fax:619-294-3437
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2016-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225000000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotic Fitter
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA5485110001Medicare NSC
CAZZZ66288ZMedicare UPIN