Provider Demographics
NPI:1720284581
Name:CASTELLANOS - MARTINEZ, MARTHA JEANNEATHE
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:JEANNEATHE
Last Name:CASTELLANOS - 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 1:120 S STATE COLLEGE BLVD STE 150
Mailing Address - Street 2:
Mailing Address - City:BREA
Mailing Address - State:CA
Mailing Address - Zip Code:92821-5837
Mailing Address - Country:US
Mailing Address - Phone:714-577-5400
Mailing Address - Fax:714-577-5450
Practice Address - Street 1:120 S STATE COLLEGE BLVD
Practice Address - Street 2:
Practice Address - City:BREA
Practice Address - State:CA
Practice Address - Zip Code:92821-5834
Practice Address - Country:US
Practice Address - Phone:714-577-5400
Practice Address - Fax:714-577-5450
Is Sole Proprietor?:No
Enumeration Date:2007-06-26
Last Update Date:2023-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA952633765OtherMEDI-CAL