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General NPI Number Information
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NPI Number | 1396021440
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Entity Type | Individual
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Provider Name | MICHELLE NICOLE MARTINEZ
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Gender | Female
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Dates
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Enumeration Date | 11/02/2011
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Last Update Date | 04/22/2025
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Provider Practice Location Address
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Address Line | 386 W LINE ST
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City | BISHOP
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State | CA
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Zip | 93514-3413
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Country | US
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Telephone | 760-709-0262
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Fax |
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Provider Business Mailing Address
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Address Line | 1840 SHOSHONE DR
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City | BISHOP
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State | CA
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Zip | 93514-8116
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Country | US
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Telephone | 760-205-2550
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 83316
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License Number State | CA
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