Provider Demographics
NPI:1518578509
Name:MARTINEZ, MABLE (CSFA)
Entity Type:Individual
Prefix:
First Name:MABLE
Middle Name:
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:CSFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3S308 TWIN PINES DR
Mailing Address - Street 2:
Mailing Address - City:WARRENVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60555-2678
Mailing Address - Country:US
Mailing Address - Phone:630-202-2625
Mailing Address - Fax:
Practice Address - Street 1:0N025 WINFIELD RD
Practice Address - Street 2:
Practice Address - City:WINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60190-1385
Practice Address - Country:US
Practice Address - Phone:630-933-1600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-12
Last Update Date:2020-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant