Provider Demographics
NPI:1720660863
Name:MARTINEZ, EMILIANO
Entity Type:Individual
Prefix:
First Name:EMILIANO
Middle Name:
Last Name:MARTINEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:930 S 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:OTHELLO
Mailing Address - State:WA
Mailing Address - Zip Code:99344-1733
Mailing Address - Country:US
Mailing Address - Phone:509-760-2164
Mailing Address - Fax:509-488-3474
Practice Address - Street 1:930 S 3RD AVE
Practice Address - Street 2:
Practice Address - City:OTHELLO
Practice Address - State:WA
Practice Address - Zip Code:99344-1733
Practice Address - Country:US
Practice Address - Phone:509-760-2164
Practice Address - Fax:509-488-3474
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-27
Last Update Date:2021-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA001171R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171R00000XOther Service ProvidersInterpreter