Provider Demographics
NPI:1356404222
Name:MARTINEZ, JESUS
Entity type:Individual
Prefix:MR
First Name:JESUS
Middle Name:
Last Name:MARTINEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:JESSE
Other - Middle Name:
Other - Last Name:MARTINEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1207 VALLEY VIEW RD
Mailing Address - Street 2:APT. D
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91202-1745
Mailing Address - Country:US
Mailing Address - Phone:818-531-2731
Mailing Address - Fax:818-241-0596
Practice Address - Street 1:1207 VALLEY VIEW RD
Practice Address - Street 2:APT. D
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91202-1745
Practice Address - Country:US
Practice Address - Phone:818-531-2731
Practice Address - Fax:818-241-0596
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-19
Last Update Date:2007-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier