Provider Demographics
NPI:1598873846
Name:MARTINEZ, ELIZABETH A (PA)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:A
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1045 ATLANTIC AVE
Mailing Address - Street 2:SUITE 705
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90813-3408
Mailing Address - Country:US
Mailing Address - Phone:562-491-9281
Mailing Address - Fax:
Practice Address - Street 1:2700 E SLAUSON AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:HUNTINGTON PARK
Practice Address - State:CA
Practice Address - Zip Code:90255-3000
Practice Address - Country:US
Practice Address - Phone:323-588-8558
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA12262363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant