Provider Demographics
NPI:1114703527
Name:MARTINEZ, TALIA M
Entity Type:Individual
Prefix:
First Name:TALIA
Middle Name:M
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 1:707 N MOUNTAIN VIEW PL
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92831-3410
Mailing Address - Country:US
Mailing Address - Phone:808-722-5429
Mailing Address - Fax:
Practice Address - Street 1:707 N MOUNTAIN VIEW PL
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92831-3410
Practice Address - Country:US
Practice Address - Phone:808-722-5429
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-01
Last Update Date:2023-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician