Provider Demographics
NPI:1669878799
Name:MARTINEZ, JOHANNA (DC, LAC)
Entity type:Individual
Prefix:DR
First Name:JOHANNA
Middle Name:
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:DC, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21780 AVALON BLVD
Mailing Address - Street 2:STE 103
Mailing Address - City:CARSON
Mailing Address - State:CA
Mailing Address - Zip Code:90745-3426
Mailing Address - Country:US
Mailing Address - Phone:310-872-3286
Mailing Address - Fax:
Practice Address - Street 1:21780 AVALON BLVD
Practice Address - Street 2:STE 103
Practice Address - City:CARSON
Practice Address - State:CA
Practice Address - Zip Code:90745-3426
Practice Address - Country:US
Practice Address - Phone:310-872-3286
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-18
Last Update Date:2016-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32916111N00000X
CA16226171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No171100000XOther Service ProvidersAcupuncturist