Provider Demographics
NPI:1235450859
Name:MARTINEZ, WINNIE ANNE FABROA
Entity Type:Individual
Prefix:
First Name:WINNIE ANNE
Middle Name:FABROA
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 1:8760 19TH STREET
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91701-9173
Mailing Address - Country:US
Mailing Address - Phone:909-989-3235
Mailing Address - Fax:909-481-0327
Practice Address - Street 1:8760 19TH STREET
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91701-9173
Practice Address - Country:US
Practice Address - Phone:909-989-3235
Practice Address - Fax:909-481-0327
Is Sole Proprietor?:No
Enumeration Date:2010-06-17
Last Update Date:2010-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA60845183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist