Provider Demographics
NPI:1508643172
Name:MARTINEZ, DENELLE N (IHSS & WPCS PROVIDER)
Entity Type:Individual
Prefix:
First Name:DENELLE
Middle Name:N
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:IHSS & WPCS PROVIDER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25809 MISSION RD
Mailing Address - Street 2:
Mailing Address - City:LOMA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92354-2520
Mailing Address - Country:US
Mailing Address - Phone:510-974-6003
Mailing Address - Fax:
Practice Address - Street 1:25809 MISSION RD
Practice Address - Street 2:
Practice Address - City:LOMA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92354-2520
Practice Address - Country:US
Practice Address - Phone:510-974-6003
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-08
Last Update Date:2023-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA003092562253Z00000X
253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care