Healthcare Provider Details

I. General information

NPI: 1730995291
Provider Name (Legal Business Name): FRANK MARTINEZ MA, PPS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/09/2024
Last Update Date: 12/09/2024
Certification Date: 12/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1660 STANLEY DR
RIPON CA
95366-3200
US

IV. Provider business mailing address

1660 STANLEY DR
RIPON CA
95366-3200
US

V. Phone/Fax

Practice location:
  • Phone: 209-599-7113
  • Fax: 209-599-2056
Mailing address:
  • Phone: 209-599-7113
  • Fax: 209-599-2056

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number200166528
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: