Healthcare Provider Details

I. General information

NPI: 1801015276
Provider Name (Legal Business Name): TIMOTHY A MARTINEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2007
Last Update Date: 10/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

604 PEARL ST
MONTEREY CA
93940-3070
US

IV. Provider business mailing address

90 WINDING WAY
WATSONVILLE CA
95076-6204
US

V. Phone/Fax

Practice location:
  • Phone: 831-649-4522
  • Fax: 831-647-9136
Mailing address:
  • Phone: 831-252-1875
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: