Provider Demographics
NPI:1942602578
Name:MARTINEZ, CATHY (RN, PHN)
Entity Type:Individual
Prefix:
First Name:CATHY
Middle Name:
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:RN, PHN
Other - Prefix:
Other - First Name:CATHY
Other - Middle Name:
Other - Last Name:MARCUM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:PO BOX 6099
Mailing Address - Street 2:BLDG 50
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92706-0099
Mailing Address - Country:US
Mailing Address - Phone:714-834-8191
Mailing Address - Fax:714-834-7780
Practice Address - Street 1:1725 W 17TH ST
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92706-2316
Practice Address - Country:US
Practice Address - Phone:714-834-8191
Practice Address - Fax:714-834-7780
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-26
Last Update Date:2014-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA642413163W00000X, 163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WC1500XNursing Service ProvidersRegistered NurseCommunity Health