Provider Demographics
NPI:1740785260
Name:MARTINEZ, CHERYL L
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:L
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 1:17100 BEAR VALLEY RD # 258
Mailing Address - Street 2:
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92395-8320
Mailing Address - Country:US
Mailing Address - Phone:760-867-9027
Mailing Address - Fax:
Practice Address - Street 1:13546 THUNDERBIRD PL
Practice Address - Street 2:
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92392-6860
Practice Address - Country:US
Practice Address - Phone:760-867-9027
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-27
Last Update Date:2018-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician