Provider Demographics
NPI:1750069357
Name:MARTINEZ, IRENE JOSIE
Entity type:Individual
Prefix:
First Name:IRENE
Middle Name:JOSIE
Last Name: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 1:9464 9TH AVE STE A
Mailing Address - Street 2:
Mailing Address - City:HESPERIA
Mailing Address - State:CA
Mailing Address - Zip Code:92345-3483
Mailing Address - Country:US
Mailing Address - Phone:442-356-0884
Mailing Address - Fax:
Practice Address - Street 1:9464 9TH AVE STE A
Practice Address - Street 2:
Practice Address - City:HESPERIA
Practice Address - State:CA
Practice Address - Zip Code:92345-3483
Practice Address - Country:US
Practice Address - Phone:442-356-0884
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-05
Last Update Date:2023-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health