Provider Demographics
NPI:1376789230
Name:MARTINEZ, NICHOLAS JAY
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:JAY
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 1:1124 BAY BLVD
Mailing Address - Street 2:SUITE D
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91911-7155
Mailing Address - Country:US
Mailing Address - Phone:619-420-3620
Mailing Address - Fax:619-420-8722
Practice Address - Street 1:1124 BAY BLVD
Practice Address - Street 2:SUITE D
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91911-7155
Practice Address - Country:US
Practice Address - Phone:619-420-3620
Practice Address - Fax:619-420-8722
Is Sole Proprietor?:No
Enumeration Date:2008-12-26
Last Update Date:2008-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator