Provider Demographics
NPI:1679799639
Name:MARTINEZ, GERALDINE LUCY (CAS)
Entity Type:Individual
Prefix:
First Name:GERALDINE
Middle Name:LUCY
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:CAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4242 AVILA LN
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95864-0761
Mailing Address - Country:US
Mailing Address - Phone:916-979-1541
Mailing Address - Fax:916-921-7569
Practice Address - Street 1:650 HOWE AVE
Practice Address - Street 2:SUITE 530
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95825-4731
Practice Address - Country:US
Practice Address - Phone:916-614-2240
Practice Address - Fax:916-921-7569
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA03-03-5875101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)