Provider Demographics
NPI:1295849776
Name:MARTEZ, THERESA ANN (ND, LMP)
Entity Type:Individual
Prefix:DR
First Name:THERESA
Middle Name:ANN
Last Name:MARTEZ
Suffix:
Gender:F
Credentials:ND, LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 CEDAR AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SNOHOMISH
Mailing Address - State:WA
Mailing Address - Zip Code:98290
Mailing Address - Country:US
Mailing Address - Phone:360-282-4014
Mailing Address - Fax:360-282-4017
Practice Address - Street 1:110 CEDAR AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:SNOHOMISH
Practice Address - State:WA
Practice Address - Zip Code:98290
Practice Address - Country:US
Practice Address - Phone:360-282-4014
Practice Address - Fax:360-282-4017
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-19
Last Update Date:2016-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANT00001430175F00000X
WANT1430175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath