Healthcare Provider Details

I. General information

NPI: 1245988591
Provider Name (Legal Business Name): CYRUS E MARTINEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/15/2022
Last Update Date: 01/09/2024
Certification Date: 01/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 E SANTA CLARA ST
SAN JOSE CA
95113-1936
US

IV. Provider business mailing address

425 E SANTA CLARA ST
SAN JOSE CA
95113-1936
US

V. Phone/Fax

Practice location:
  • Phone: 669-245-3429
  • Fax: 408-550-7433
Mailing address:
  • Phone: 669-245-3429
  • Fax: 408-550-7433

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: