Provider Demographics
NPI:1699036194
Name:MARTINEZ, ANGELICA BEJAR (DO)
Entity Type:Individual
Prefix:
First Name:ANGELICA
Middle Name:BEJAR
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:ANGELICA
Other - Middle Name:
Other - Last Name:BEJAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:30809 1ST AVE S
Mailing Address - Street 2:
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98003-4074
Mailing Address - Country:US
Mailing Address - Phone:253-839-2030
Mailing Address - Fax:253-207-4240
Practice Address - Street 1:30809 1ST AVE S
Practice Address - Street 2:
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-4074
Practice Address - Country:US
Practice Address - Phone:253-839-2030
Practice Address - Fax:253-207-4240
Is Sole Proprietor?:No
Enumeration Date:2012-06-01
Last Update Date:2020-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOP60560577207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2047006Medicaid