Healthcare Provider Details

I. General information

NPI: 1245653955
Provider Name (Legal Business Name): GERARDO MARTINEZ JR. C.M.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/31/2014
Last Update Date: 01/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44825 LAS PALMAS AVE APT.1
PALM DESERT CA
92260
US

IV. Provider business mailing address

44825 LAS PALMAS AVE APT.1
PALM DESERT CA
92260
US

V. Phone/Fax

Practice location:
  • Phone: 760-766-6366
  • Fax:
Mailing address:
  • Phone: 760-766-6366
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number4668
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code173C00000X
TaxonomyReflexologist
License Number
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code175L00000X
TaxonomyHomeopath
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: