Healthcare Provider Details

I. General information

NPI: 1689010621
Provider Name (Legal Business Name): JOANNA MARTINEZ B.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2013
Last Update Date: 05/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1255 ALLSTON WAY
BERKELEY CA
94702-1833
US

IV. Provider business mailing address

1255 ALLSTON WAY
BERKELEY CA
94702-1833
US

V. Phone/Fax

Practice location:
  • Phone: 510-845-9010
  • Fax: 510-849-1421
Mailing address:
  • Phone: 510-845-9010
  • Fax: 510-849-1421

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: