Provider Demographics
NPI:1568501559
Name:MARTINEZ, EMMANUEL OWEN ARSENI PICACHE (MD)
Entity Type:Individual
Prefix:
First Name:EMMANUEL OWEN ARSENI
Middle Name:PICACHE
Last Name:MARTINEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16259 SYLVESTER RD SW STE 502
Mailing Address - Street 2:
Mailing Address - City:BURIEN
Mailing Address - State:WA
Mailing Address - Zip Code:98166-3059
Mailing Address - Country:US
Mailing Address - Phone:206-835-7440
Mailing Address - Fax:206-835-7459
Practice Address - Street 1:16259 SYLVESTER RD SW STE 503
Practice Address - Street 2:
Practice Address - City:BURIEN
Practice Address - State:WA
Practice Address - Zip Code:98166-3059
Practice Address - Country:US
Practice Address - Phone:206-835-7440
Practice Address - Fax:206-835-7459
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2006-04032084N0400X
KS04-345262084N0400X, 2084N0402X, 2084N0600X, 2084N0600X
WAMD608234772084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child Neurology
No2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical Neurophysiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2116907Medicaid
KS110426011Medicare PIN