Provider Demographics
NPI:1376045567
Name:MARTINEZ, EUGENE TEOFILO
Entity Type:Individual
Prefix:
First Name:EUGENE
Middle Name:TEOFILO
Last Name:MARTINEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2725 DORIS CT
Mailing Address - Street 2:
Mailing Address - City:CARMICHAEL
Mailing Address - State:CA
Mailing Address - Zip Code:95608-4601
Mailing Address - Country:US
Mailing Address - Phone:916-229-7468
Mailing Address - Fax:
Practice Address - Street 1:2725 DORIS CT
Practice Address - Street 2:
Practice Address - City:CARMICHAEL
Practice Address - State:CA
Practice Address - Zip Code:95608-4601
Practice Address - Country:US
Practice Address - Phone:916-229-7468
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-02
Last Update Date:2018-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician