Healthcare Provider Details

I. General information

NPI: 1578133260
Provider Name (Legal Business Name): LUIS ANTONIO MARTINEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/25/2021
Last Update Date: 04/30/2024
Certification Date: 04/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

875 GEER RD
TURLOCK CA
95380-3311
US

IV. Provider business mailing address

875 GEER RD
TURLOCK CA
95380-3311
US

V. Phone/Fax

Practice location:
  • Phone: 209-633-3057
  • Fax:
Mailing address:
  • Phone: 209-633-3057
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: