Provider Demographics
NPI:1134803679
Name:MARTIN, CLESTER VERA
Entity type:Individual
Prefix:
First Name:CLESTER
Middle Name:VERA
Last Name:MARTIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CLESTER
Other - Middle Name:VERA
Other - Last Name:MARTIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CLESTER MARTIN
Mailing Address - Street 1:2120 RAMROD AVE
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89014-2008
Mailing Address - Country:US
Mailing Address - Phone:775-745-8276
Mailing Address - Fax:
Practice Address - Street 1:615 N ST
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93304-2152
Practice Address - Country:US
Practice Address - Phone:661-717-8465
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-14
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist