Provider Demographics
NPI:1801395421
Name:MARTIN, KEDRIC E
Entity type:Individual
Prefix:
First Name:KEDRIC
Middle Name:E
Last Name:MARTIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:MARTIN
Other - Middle Name:
Other - Last Name:TRANSPORTATION
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:2919 VALIANT ELM ST
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:TX
Mailing Address - Zip Code:77545-8161
Mailing Address - Country:US
Mailing Address - Phone:713-575-4612
Mailing Address - Fax:
Practice Address - Street 1:2919 VALIANT ELM ST
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:TX
Practice Address - Zip Code:77545-8161
Practice Address - Country:US
Practice Address - Phone:713-575-4612
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-09
Last Update Date:2018-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)