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General NPI Number Information
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NPI Number | 1043353972
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Entity Type | Organization
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Legal Business Name | MIKE T MARTINEZ
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Dates
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Enumeration Date | 02/14/2007
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Last Update Date | 02/12/2008
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Provider Practice Location Address
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Address Line | 2222 WATT AVE STE C9
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City | SACRAMENTO
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State | CA
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Zip | 95825-0581
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Country | US
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Telephone | 916-488-1478
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Fax | 916-488-1807
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Provider Business Mailing Address
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Address Line | 2222 WATT AVE STE C9
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City | SACRAMENTO
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State | CA
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Zip | 95825-0581
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Country | US
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Telephone | 916-488-1478
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Fax | 916-488-1807
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. MIKE MARTINEZ
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Credential | CO
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Telephone | 916-488-1478
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 222Z00000X
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Taxonomy Name | Orthotist
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License Number |
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License Number State |
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