Healthcare Provider Details

I. General information

NPI: 1184920878
Provider Name (Legal Business Name): JAIME MARTINEZ
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/28/2011
Last Update Date: 01/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1911 WILLIAMS DR
OXNARD CA
93036-2612
US

IV. Provider business mailing address

1911 WILLIAMS DR
OXNARD CA
93036-2612
US

V. Phone/Fax

Practice location:
  • Phone: 805-981-9270
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. JAIME MARTINEZ
Title or Position: MENTAL HEALTH ASSOCIATE
Credential: B.A.
Phone: 805-889-7408