Provider Demographics
NPI:1881000420
Name:MARTINEZ, LANI SUGITA (DPT)
Entity Type:Individual
Prefix:MRS
First Name:LANI
Middle Name:SUGITA
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:LANI
Other - Middle Name:SUGITA
Other - Last Name:AGSALUD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:846 W. FOOTHILL BLVD.
Mailing Address - Street 2:SUITE C
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786
Mailing Address - Country:US
Mailing Address - Phone:909-985-8686
Mailing Address - Fax:909-985-5706
Practice Address - Street 1:846 W. FOOTHILL BLVD.
Practice Address - Street 2:SUITE C
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786
Practice Address - Country:US
Practice Address - Phone:909-985-8686
Practice Address - Fax:909-985-5706
Is Sole Proprietor?:No
Enumeration Date:2014-07-03
Last Update Date:2014-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program