Provider Demographics
NPI:1902240336
Name:MARTINEZ, MICHELE D (LVN)
Entity Type:Individual
Prefix:MS
First Name:MICHELE
Middle Name:D
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:151 KALMUS DRIVE, SUITE K-3
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626
Mailing Address - Country:US
Mailing Address - Phone:714-384-3870
Mailing Address - Fax:
Practice Address - Street 1:151 KALMUS DR
Practice Address - Street 2:SUITE K-3
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626-5988
Practice Address - Country:US
Practice Address - Phone:714-384-3870
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-29
Last Update Date:2013-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN253189164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse