Healthcare Provider Details

I. General information

NPI: 1144976267
Provider Name (Legal Business Name): CATERINE MICHELLE MARTINEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2022
Last Update Date: 04/18/2022
Certification Date: 03/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13510 MONTFORT AVE
HERALD CA
95638-9761
US

IV. Provider business mailing address

9701 DINO DR
ELK GROVE CA
95624-4025
US

V. Phone/Fax

Practice location:
  • Phone: 916-420-5383
  • Fax:
Mailing address:
  • Phone: 916-892-0013
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: