Provider Demographics
NPI:1023262995
Name:MARTINEZ, JACOB NATHANAEL (CFA)
Entity type:Individual
Prefix:MR
First Name:JACOB
Middle Name:NATHANAEL
Last Name:MARTINEZ
Suffix:
Gender:M
Credentials:CFA
Other - Prefix:
Other - First Name:JAKE
Other - Middle Name:NATHANAEL
Other - Last Name:MARTINEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CFA
Mailing Address - Street 1:3410 MERRYVALE RD
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97404-3870
Mailing Address - Country:US
Mailing Address - Phone:541-556-9051
Mailing Address - Fax:
Practice Address - Street 1:3410 MERRYVALE RD
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97404-3870
Practice Address - Country:US
Practice Address - Phone:541-556-9051
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-05
Last Update Date:2008-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR104266246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant