Provider Demographics
NPI:1700370178
Name:MARTINEZ, NATALIE (MS, DIV)
Entity Type:Individual
Prefix:MS
First Name:NATALIE
Middle Name:
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:MS, DIV
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3528 I ST STE 1
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19134-1449
Mailing Address - Country:US
Mailing Address - Phone:215-425-5099
Mailing Address - Fax:215-425-5199
Practice Address - Street 1:3528 I ST STE 1
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19134
Practice Address - Country:US
Practice Address - Phone:215-425-5099
Practice Address - Fax:215-425-5199
Is Sole Proprietor?:No
Enumeration Date:2018-06-19
Last Update Date:2018-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1032437850001Medicaid