Provider Demographics
NPI:1346792736
Name:MARTINEZ, MANUEL JESUS JR (RN)
Entity Type:Individual
Prefix:MR
First Name:MANUEL
Middle Name:JESUS
Last Name:MARTINEZ
Suffix:JR
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3107 S GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90007-3816
Mailing Address - Country:US
Mailing Address - Phone:213-744-8186
Mailing Address - Fax:213-744-1688
Practice Address - Street 1:3107 S GRAND AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90007-3816
Practice Address - Country:US
Practice Address - Phone:213-744-1688
Practice Address - Fax:213-744-1688
Is Sole Proprietor?:No
Enumeration Date:2016-11-01
Last Update Date:2016-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA786967163WA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)