Provider Demographics
NPI:1508571480
Name:MARTINEZ, SARA JOELLE
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:JOELLE
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 1:10870 N RAMSEY RD
Mailing Address - Street 2:
Mailing Address - City:HAYDEN
Mailing Address - State:ID
Mailing Address - Zip Code:83835-9799
Mailing Address - Country:US
Mailing Address - Phone:208-640-3704
Mailing Address - Fax:
Practice Address - Street 1:6795 N MINERAL DR
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83815-8700
Practice Address - Country:US
Practice Address - Phone:208-620-5200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-16
Last Update Date:2023-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator