Provider Demographics
NPI:1801556253
Name:MARTINEZ, JENNY LAURA
Entity type:Individual
Prefix:
First Name:JENNY
Middle Name:LAURA
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 1:793 GARDEN GATE DR
Mailing Address - Street 2:
Mailing Address - City:MANTECA
Mailing Address - State:CA
Mailing Address - Zip Code:95336-3700
Mailing Address - Country:US
Mailing Address - Phone:209-855-6156
Mailing Address - Fax:
Practice Address - Street 1:13078 FOX CT
Practice Address - Street 2:
Practice Address - City:GROVELAND
Practice Address - State:CA
Practice Address - Zip Code:95321-9540
Practice Address - Country:US
Practice Address - Phone:209-855-6156
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-27
Last Update Date:2021-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other