Provider Demographics
NPI:1376893495
Name:MARTINEZ, KIMBERLY PATRICIA (LVN)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:PATRICIA
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:226 S CLOVIS AVE APT 115
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93727-4283
Mailing Address - Country:US
Mailing Address - Phone:559-905-5683
Mailing Address - Fax:
Practice Address - Street 1:226 S CLOVIS AVE APT 115
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93727-4283
Practice Address - Country:US
Practice Address - Phone:559-905-5683
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-17
Last Update Date:2012-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN248114164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse