MEDICARE: ERIC EMILIO MARTINEZ ATC, EMT

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	2255A2300X	Athletic Trainer	2000021961	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	E116263	OTHER	CA	EMERGENCY MEDICAL TECHNICIAN

General Provider Information

NPI Number	:	1528504230
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERIC EMILIO MARTINEZ ATC, EMT

Provider Business Mailing Address
First Line	:	3134 SAN ANGELO AVE
Second Line	:
City	:	SIMI VALLEY
State	:	CA
Zip	:	93063-1929
Country	:	US
Telephone Number	:	805-915-8616
Fax Number	:

Provider Business Practice Location Address
First Line	:	3134 SAN ANGELO AVE
Second Line	:
City	:	SIMI VALLEY
State	:	CA
Zip	:	93063-1929
Country	:	US
Telephone Number	:	805-915-8616
Fax Number	:

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

Provider Enumeration Date	:	01/19/2017
Last Update Date	:	01/19/2017

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