Healthcare Provider Details

I. General information

NPI: 1982250668
Provider Name (Legal Business Name): NICHOLAS MARTINEZ DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2019
Last Update Date: 01/03/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1721 TECHNOLOGY DR
SAN JOSE CA
95110-1305
US

IV. Provider business mailing address

1510 S BASCOM AVE
CAMPBELL CA
95008-0626
US

V. Phone/Fax

Practice location:
  • Phone: 408-436-3300
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number297238
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: