Provider Demographics
NPI:1861861221
Name:MARTINEZ, NORMA
Entity Type:Individual
Prefix:
First Name:NORMA
Middle Name:
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 1:1605 N 6TH PL
Mailing Address - Street 2:
Mailing Address - City:PORT HUENEME
Mailing Address - State:CA
Mailing Address - Zip Code:93041-2411
Mailing Address - Country:US
Mailing Address - Phone:805-469-4803
Mailing Address - Fax:805-385-7279
Practice Address - Street 1:160 SIXTH PLACE
Practice Address - Street 2:
Practice Address - City:PORT HUENEME
Practice Address - State:CA
Practice Address - Zip Code:93041
Practice Address - Country:US
Practice Address - Phone:805-469-4803
Practice Address - Fax:805-385-7279
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-16
Last Update Date:2015-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16-00004654343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)