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General NPI Number Information
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NPI Number | 1114752060
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Entity Type | Individual
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Provider Name | SAMANTHA MARTINEZ
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Gender | Female
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Dates
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Enumeration Date | 09/02/2024
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Last Update Date | 07/02/2025
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Provider Practice Location Address
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Address Line | 931 10TH ST STE 776
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City | MODESTO
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State | CA
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Zip | 95354-2305
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Country | US
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Telephone | 832-489-3172
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Fax |
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Provider Business Mailing Address
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Address Line | 12437 LEWIS ST STE 100
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City | GARDEN GROVE
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State | CA
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Zip | 92840-4651
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Country | US
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Telephone | 805-613-7266
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225400000X
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Taxonomy Name | Rehabilitation Practitioner
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number |
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License Number State |
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