Provider Demographics
NPI:1669007738
Name:MARTINEZ, SARA RENAE (COTA/L)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:RENAE
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9908 KIKA CT APT 822
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92129-5008
Mailing Address - Country:US
Mailing Address - Phone:602-499-8548
Mailing Address - Fax:
Practice Address - Street 1:1461 MERRITT DR
Practice Address - Street 2:
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92020-7862
Practice Address - Country:US
Practice Address - Phone:858-945-3243
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-09
Last Update Date:2020-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA4987224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant