MEDICARE: CESAR MARTINEZ PENA CMT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist	72120	CA

General Provider Information

NPI Number	:	1083445217
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CESAR MARTINEZ PENA CMT

Provider Business Mailing Address
First Line	:	5315 WHITE OAK AVE UNIT J
Second Line	:
City	:	ENCINO
State	:	CA
Zip	:	91316-4533
Country	:	US
Telephone Number	:	818-481-4191
Fax Number	:

Provider Business Practice Location Address
First Line	:	5315 WHITE OAK AVE UNIT J
Second Line	:
City	:	ENCINO
State	:	CA
Zip	:	91316-4533
Country	:	US
Telephone Number	:	818-481-4191
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/09/2024
Last Update Date	:	08/09/2024

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