Healthcare Provider Details

I. General information

NPI: 1194440388
Provider Name (Legal Business Name): SERGIO MARTINEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/10/2022
Last Update Date: 04/22/2026
Certification Date: 04/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8720 14TH AVE S
SEATTLE WA
98108-4807
US

IV. Provider business mailing address

1115 W CALL ST
TALLAHASSEE FL
32304-3556
US

V. Phone/Fax

Practice location:
  • Phone: 206-762-3730
  • Fax: 206-764-0523
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA70085532
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: