Provider Demographics
NPI:1265658975
Name:MARTIN, JANET J
Entity Type:Individual
Prefix:
First Name:JANET
Middle Name:J
Last Name:MARTIN
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 1:360 WHISKEY HILL RD
Mailing Address - Street 2:
Mailing Address - City:LA SELVA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:95076-8521
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:360 WHISKEY HILL RD
Practice Address - Street 2:
Practice Address - City:LA SELVA BEACH
Practice Address - State:CA
Practice Address - Zip Code:95076-8521
Practice Address - Country:US
Practice Address - Phone:831-724-9333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2017-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ92069ZOtherSANTA CRUZ MEDICAL GROUP PTAN#