Healthcare Provider Details

I. General information

NPI: 1144789736
Provider Name (Legal Business Name): DONTE MARTINEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/14/2019
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2633 E 27TH ST
OAKLAND CA
94601-1912
US

IV. Provider business mailing address

2633 E 27TH ST
OAKLAND CA
94601-1912
US

V. Phone/Fax

Practice location:
  • Phone: 510-940-6134
  • Fax:
Mailing address:
  • Phone: 510-940-6134
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: