Provider Demographics
NPI:1497534366
Name:MARTINEZ, VANESSA JUDITH
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:JUDITH
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1128 MAYOR AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93706-3128
Mailing Address - Country:US
Mailing Address - Phone:303-435-9943
Mailing Address - Fax:
Practice Address - Street 1:1911 N FINE AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93727-1510
Practice Address - Country:US
Practice Address - Phone:303-435-9943
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-28
Last Update Date:2023-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program