Provider Demographics
NPI:1558491407
Name:MARTINEZ, GLORIA (MA)
Entity type:Individual
Prefix:
First Name:GLORIA
Middle Name:
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:GLORIA
Other - Middle Name:YESENIA
Other - Last Name:SANCHEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:18350 HATTERAS ST APT 122
Mailing Address - Street 2:
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91356-1666
Mailing Address - Country:US
Mailing Address - Phone:805-886-7684
Mailing Address - Fax:
Practice Address - Street 1:4401 CRENSHAW BLVD
Practice Address - Street 2:SUITE 300
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90043-1227
Practice Address - Country:US
Practice Address - Phone:323-290-8360
Practice Address - Fax:323-290-8366
Is Sole Proprietor?:No
Enumeration Date:2007-03-07
Last Update Date:2024-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner