Provider Demographics
NPI:1508171232
Name:MARTINEZ, ANA LAURA (LMP)
Entity Type:Individual
Prefix:
First Name:ANA
Middle Name:LAURA
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3180 W CLEARWATER AVE
Mailing Address - Street 2:STE F
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336-2767
Mailing Address - Country:US
Mailing Address - Phone:509-783-6677
Mailing Address - Fax:
Practice Address - Street 1:3180 W CLEARWATER AVE
Practice Address - Street 2:STE F
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-2767
Practice Address - Country:US
Practice Address - Phone:509-783-6677
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-18
Last Update Date:2011-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60059427225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist