Provider Demographics
NPI:1669688248
Name:MARTINEZ, JERRY ANTHONY
Entity Type:Individual
Prefix:
First Name:JERRY
Middle Name:ANTHONY
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 1:1083 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SALINAS
Mailing Address - State:CA
Mailing Address - Zip Code:93901-2323
Mailing Address - Country:US
Mailing Address - Phone:831-424-4828
Mailing Address - Fax:831-424-5838
Practice Address - Street 1:1083 S MAIN ST
Practice Address - Street 2:
Practice Address - City:SALINAS
Practice Address - State:CA
Practice Address - Zip Code:93901-2323
Practice Address - Country:US
Practice Address - Phone:831-424-4828
Practice Address - Fax:831-424-5838
Is Sole Proprietor?:No
Enumeration Date:2007-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)