Provider Demographics
NPI:1497421879
Name:MARTINEZ, ANDRES VINCENT
Entity Type:Individual
Prefix:
First Name:ANDRES
Middle Name:VINCENT
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:PO BOX 5091
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93278-5091
Mailing Address - Country:US
Mailing Address - Phone:559-747-3984
Mailing Address - Fax:
Practice Address - Street 1:6200 S MOONEY BLVD
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93277-9396
Practice Address - Country:US
Practice Address - Phone:559-747-3984
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-17
Last Update Date:2021-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health