Provider Demographics
NPI:1477904001
Name:MARTINEZ, ANTONIO MARTINEZ JR
Entity Type:Individual
Prefix:
First Name:ANTONIO
Middle Name:MARTINEZ
Last Name:MARTINEZ
Suffix:JR
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 1:46900 MONROE ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:INDIO
Mailing Address - State:CA
Mailing Address - Zip Code:92201-4827
Mailing Address - Country:US
Mailing Address - Phone:760-863-7219
Mailing Address - Fax:760-863-8777
Practice Address - Street 1:46900 MONROE ST
Practice Address - Street 2:SUITE 101
Practice Address - City:INDIO
Practice Address - State:CA
Practice Address - Zip Code:92201-4827
Practice Address - Country:US
Practice Address - Phone:760-863-7219
Practice Address - Fax:760-863-8777
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-24
Last Update Date:2016-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist