Provider Demographics
NPI:1326763798
Name:MARTINEZ RAMIREZ, ESMERALDA I
Entity Type:Individual
Prefix:
First Name:ESMERALDA
Middle Name:
Last Name:MARTINEZ RAMIREZ
Suffix:I
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 1:5030 3/4 CLARA ST
Mailing Address - Street 2:
Mailing Address - City:CUDAHY
Mailing Address - State:CA
Mailing Address - Zip Code:90201-4493
Mailing Address - Country:US
Mailing Address - Phone:562-240-3328
Mailing Address - Fax:
Practice Address - Street 1:1200 CONCORD AVE STE 100
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94520-4969
Practice Address - Country:US
Practice Address - Phone:510-268-8120
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-07
Last Update Date:2023-12-14
Deactivation Date:2023-09-14
Deactivation Code:
Reactivation Date:2023-12-06
Provider Licenses
StateLicense IDTaxonomies
CA106S00000X, 390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician