Provider Demographics
NPI:1912772625
Name:MARTINEZ, LISA CHRISTINA (ATC, CFO)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:CHRISTINA
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:ATC, CFO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3535 EL PORTAL DR APT B204
Mailing Address - Street 2:
Mailing Address - City:EL SOBRANTE
Mailing Address - State:CA
Mailing Address - Zip Code:94803-2765
Mailing Address - Country:US
Mailing Address - Phone:916-410-3919
Mailing Address - Fax:
Practice Address - Street 1:400 PARNASSUS AVE RM A096
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94143-2202
Practice Address - Country:US
Practice Address - Phone:415-476-1788
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-22
Last Update Date:2023-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACFO05773225000000X
CA20000152882255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No225000000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotic Fitter