Provider Demographics
NPI:1578270963
Name:PEREZ MARTINEZ, IZABELLA DOMENIQUE (LMT)
Entity Type:Individual
Prefix:
First Name:IZABELLA
Middle Name:DOMENIQUE
Last Name:PEREZ 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 1:109 N IONE ST
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336-3556
Mailing Address - Country:US
Mailing Address - Phone:509-572-1213
Mailing Address - Fax:
Practice Address - Street 1:333 W CANAL DR
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-3845
Practice Address - Country:US
Practice Address - Phone:509-572-1213
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-03
Last Update Date:2022-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA61316361225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist