Provider Demographics
NPI:1629627393
Name:MARTINEZ, ANTONIO RAMON
Entity Type:Individual
Prefix:
First Name:ANTONIO
Middle Name:RAMON
Last Name:MARTINEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3141 BLUE BUTTERFLY WAY UNIT 66
Mailing Address - Street 2:
Mailing Address - City:SAN PEDRO
Mailing Address - State:CA
Mailing Address - Zip Code:90732
Mailing Address - Country:US
Mailing Address - Phone:626-464-0820
Mailing Address - Fax:
Practice Address - Street 1:3141 BLUE BUTTERFLY UNIT 66
Practice Address - Street 2:
Practice Address - City:SAN PEDRO
Practice Address - State:CA
Practice Address - Zip Code:90732
Practice Address - Country:US
Practice Address - Phone:626-464-0820
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-05
Last Update Date:2019-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider