Provider Demographics
NPI:1578294831
Name:MARTINEZ, ISABEL N/A
Entity Type:Individual
Prefix:
First Name:ISABEL
Middle Name:N/A
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4030 MOONPARK AVENUE
Mailing Address - Street 2:SUITE #105
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95117-1129
Mailing Address - Country:US
Mailing Address - Phone:669-205-1778
Mailing Address - Fax:855-568-2494
Practice Address - Street 1:4030 MOONPARK AVENUE
Practice Address - Street 2:SUITE #105
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95117-1129
Practice Address - Country:US
Practice Address - Phone:669-205-1778
Practice Address - Fax:855-568-2494
Is Sole Proprietor?:No
Enumeration Date:2022-06-17
Last Update Date:2022-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAXXXXXXX106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician