Provider Demographics
NPI:1649071614
Name:MARTINEZ, ANGELIZ MARIE
Entity type:Individual
Prefix:
First Name:ANGELIZ
Middle Name:MARIE
Last Name:MARTINEZ
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1904 E 29TH ST
Mailing Address - Street 2:
Mailing Address - City:LORAIN
Mailing Address - State:OH
Mailing Address - Zip Code:44055-1911
Mailing Address - Country:US
Mailing Address - Phone:440-371-7456
Mailing Address - Fax:440-371-7456
Practice Address - Street 1:1904 E 29TH ST
Practice Address - Street 2:
Practice Address - City:LORAIN
Practice Address - State:OH
Practice Address - Zip Code:44055-1911
Practice Address - Country:US
Practice Address - Phone:440-371-7456
Practice Address - Fax:440-371-7456
Is Sole Proprietor?:No
Enumeration Date:2025-03-24
Last Update Date:2025-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator