Provider Demographics
NPI:1760845382
Name:MARTINEZ, JOELLA (PA-C)
Entity Type:Individual
Prefix:
First Name:JOELLA
Middle Name:
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42575 WASHINGTON STREET
Mailing Address - Street 2:
Mailing Address - City:PALM DESERT
Mailing Address - State:CA
Mailing Address - Zip Code:92211-8850
Mailing Address - Country:US
Mailing Address - Phone:760-360-0333
Mailing Address - Fax:
Practice Address - Street 1:42575 WASHINGTON STREET
Practice Address - Street 2:
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92211-8850
Practice Address - Country:US
Practice Address - Phone:760-360-0333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-31
Last Update Date:2016-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA53430363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant