Provider Demographics
NPI:1497880744
Name:MARTINEZ, RUDOLPH ALBERT (BSW)
Entity Type:Individual
Prefix:MR
First Name:RUDOLPH
Middle Name:ALBERT
Last Name:MARTINEZ
Suffix:
Gender:M
Credentials:BSW
Other - Prefix:MR
Other - First Name:RUDY
Other - Middle Name:ALBERT
Other - Last Name:MARTINEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:BSW
Mailing Address - Street 1:15107 WALBROOK DR
Mailing Address - Street 2:
Mailing Address - City:HACIENDA HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:91745-1431
Mailing Address - Country:US
Mailing Address - Phone:626-330-3008
Mailing Address - Fax:
Practice Address - Street 1:1126 N GRAND AVE
Practice Address - Street 2:
Practice Address - City:COVINA
Practice Address - State:CA
Practice Address - Zip Code:91724-1551
Practice Address - Country:US
Practice Address - Phone:626-967-1667
Practice Address - Fax:626-967-6027
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner