Provider Demographics
NPI:1922275734
Name:MARTINEZ, ALICIA (MA)
Entity Type:Individual
Prefix:MS
First Name:ALICIA
Middle Name:
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:540 10TH ST
Mailing Address - Street 2:
Mailing Address - City:IMPERIAL BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:91932-1513
Mailing Address - Country:US
Mailing Address - Phone:619-423-0211
Mailing Address - Fax:619-423-0211
Practice Address - Street 1:540 10TH ST
Practice Address - Street 2:
Practice Address - City:IMPERIAL BEACH
Practice Address - State:CA
Practice Address - Zip Code:91932-1513
Practice Address - Country:US
Practice Address - Phone:619-423-0211
Practice Address - Fax:619-423-0211
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-12
Last Update Date:2008-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA053279374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide