Provider Demographics
NPI:1528222056
Name:MARTINEZ, TIANNA RENEE (LMT)
Entity Type:Individual
Prefix:
First Name:TIANNA
Middle Name:RENEE
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19691 SUN CIR
Mailing Address - Street 2:
Mailing Address - City:WEST LINN
Mailing Address - State:OR
Mailing Address - Zip Code:97068-1913
Mailing Address - Country:US
Mailing Address - Phone:503-250-0648
Mailing Address - Fax:
Practice Address - Street 1:19691 SUN CIR
Practice Address - Street 2:
Practice Address - City:WEST LINN
Practice Address - State:OR
Practice Address - Zip Code:97068-1913
Practice Address - Country:US
Practice Address - Phone:503-250-0648
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-14
Last Update Date:2008-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR11857174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist