Provider Demographics
NPI:1407868870
Name:LENE V.M. MARTINEZ, M.D.
Entity Type:Organization
Organization Name:LENE V.M. MARTINEZ, M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LENE
Authorized Official - Middle Name:VIDOLA MISSION
Authorized Official - Last Name:MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:510-818-9100
Mailing Address - Street 1:2287 MOWRY AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94538-1622
Mailing Address - Country:US
Mailing Address - Phone:510-818-9100
Mailing Address - Fax:510-818-9901
Practice Address - Street 1:2287 MOWRY AVE
Practice Address - Street 2:SUITE B
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-1622
Practice Address - Country:US
Practice Address - Phone:510-818-9100
Practice Address - Fax:510-818-9901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA-29347174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A293470Medicare ID - Type Unspecified
CAA25747Medicare UPIN