MEDICARE: MR. FIDEL MARTINEZ LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	LCS9505	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	CMS171130	OTHER	CA	MEDICAL PROVIDER NUMBER
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1528180049
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. FIDEL MARTINEZ LCSW

Provider Business Mailing Address
First Line	:	1285 DOREMUS RD
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91105-2768
Country	:	US
Telephone Number	:	323-646-1555
Fax Number	:

Provider Business Practice Location Address
First Line	:	1285 DOREMUS RD
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91105-2768
Country	:	US
Telephone Number	:	323-646-1555
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/04/2007
Last Update Date	:	09/14/2007

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