Provider Demographics
NPI:1952902132
Name:MARTINEZ, MARIA G
Entity Type:Individual
Prefix:MRS
First Name:MARIA
Middle Name:G
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 1:2025 N D ST
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92405-3913
Mailing Address - Country:US
Mailing Address - Phone:909-475-8793
Mailing Address - Fax:
Practice Address - Street 1:6260 HETTY ST
Practice Address - Street 2:
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92336-1036
Practice Address - Country:US
Practice Address - Phone:909-904-7504
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-04
Last Update Date:2020-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker