Provider Demographics
NPI:1629490362
Name:MARTINEZ, OLIVIA DANIELLE (FP-C)
Entity Type:Individual
Prefix:
First Name:OLIVIA
Middle Name:DANIELLE
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:FP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:416 CEDAR ST
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93304-2517
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2557 MOWRY AVE
Practice Address - Street 2:SUITE 25
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-1603
Practice Address - Country:US
Practice Address - Phone:855-717-1755
Practice Address - Fax:661-459-1944
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-15
Last Update Date:2016-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA23056363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily