Provider Demographics
NPI:1457015232
Name:MARTINEZ, JESSE
Entity Type:Individual
Prefix:
First Name:JESSE
Middle Name:
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 1:1051 PINELOCH DR STE 400
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77062-2739
Mailing Address - Country:US
Mailing Address - Phone:281-461-6888
Mailing Address - Fax:866-237-5824
Practice Address - Street 1:1051 PINELOCH DR STE 400
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77062-2739
Practice Address - Country:US
Practice Address - Phone:281-461-6888
Practice Address - Fax:866-237-5824
Is Sole Proprietor?:No
Enumeration Date:2021-10-27
Last Update Date:2021-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician