Provider Demographics
NPI:1710602008
Name:MARTINEZ, TOMALIKIA TAMU
Entity Type:Individual
Prefix:
First Name:TOMALIKIA
Middle Name:TAMU
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1465 165TH AVE APT 208
Mailing Address - Street 2:
Mailing Address - City:SAN LEANDRO
Mailing Address - State:CA
Mailing Address - Zip Code:94578-3140
Mailing Address - Country:US
Mailing Address - Phone:341-899-6637
Mailing Address - Fax:
Practice Address - Street 1:1465 165TH AVE APT 208
Practice Address - Street 2:
Practice Address - City:SAN LEANDRO
Practice Address - State:CA
Practice Address - Zip Code:94578-3140
Practice Address - Country:US
Practice Address - Phone:341-899-6637
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-10
Last Update Date:2022-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA002672826251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health