Provider Demographics
NPI:1114588621
Name:MARTINEZ, STEPHANIE DELGADO
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:DELGADO
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 1:3715 COLUMBUS ST
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93306-2719
Mailing Address - Country:US
Mailing Address - Phone:661-868-7168
Mailing Address - Fax:
Practice Address - Street 1:3715 COLUMBUS ST
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93306-2719
Practice Address - Country:US
Practice Address - Phone:661-868-7168
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-25
Last Update Date:2019-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0000000000OtherMEDICAL