Provider Demographics
NPI:1851737878
Name:MARTINEZ, GILMA STEPHANIE
Entity Type:Individual
Prefix:
First Name:GILMA
Middle Name:STEPHANIE
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 1:1693 CAFFREY LN
Mailing Address - Street 2:
Mailing Address - City:WEST COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91791-4142
Mailing Address - Country:US
Mailing Address - Phone:909-247-6252
Mailing Address - Fax:
Practice Address - Street 1:1693 CAFFREY LN
Practice Address - Street 2:
Practice Address - City:WEST COVINA
Practice Address - State:CA
Practice Address - Zip Code:91791-4142
Practice Address - Country:US
Practice Address - Phone:909-247-6252
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-16
Last Update Date:2015-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT36826167G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes167G00000XNursing Service ProvidersLicensed Psychiatric Technician