Healthcare Provider Details

I. General information

NPI: 1881067775
Provider Name (Legal Business Name): AMELIA MARTINEZ RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/02/2015
Last Update Date: 11/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1441 CONSTITUTION BLVD STE 16
SALINAS CA
93906-3100
US

IV. Provider business mailing address

1441 CONSTITUTION BLVD STE 16
SALINAS CA
93906-3100
US

V. Phone/Fax

Practice location:
  • Phone: 831-769-8640
  • Fax: 831-769-8632
Mailing address:
  • Phone: 831-769-8640
  • Fax: 831-769-8632

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number731115
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: