Provider Demographics
NPI:1477372704
Name:MARTINEZ, AUBREY ELIZABETH
Entity type:Individual
Prefix:
First Name:AUBREY
Middle Name:ELIZABETH
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1114 E 3RD ST
Mailing Address - Street 2:
Mailing Address - City:EMMETT
Mailing Address - State:ID
Mailing Address - Zip Code:83617-3311
Mailing Address - Country:US
Mailing Address - Phone:208-963-0349
Mailing Address - Fax:
Practice Address - Street 1:1114 E 3RD ST
Practice Address - Street 2:
Practice Address - City:EMMETT
Practice Address - State:ID
Practice Address - Zip Code:83617-3311
Practice Address - Country:US
Practice Address - Phone:208-963-0349
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-03
Last Update Date:2024-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician