Provider Demographics
NPI:1134419153
Name:MARTINEZ, ILIANA
Entity type:Individual
Prefix:MISS
First Name:ILIANA
Middle Name:
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:317 N LOVEKIN BLVD
Mailing Address - Street 2:
Mailing Address - City:BLYTHE
Mailing Address - State:CA
Mailing Address - Zip Code:92225-1441
Mailing Address - Country:US
Mailing Address - Phone:760-574-5683
Mailing Address - Fax:
Practice Address - Street 1:317 N LOVEKIN BLVD
Practice Address - Street 2:
Practice Address - City:BLYTHE
Practice Address - State:CA
Practice Address - Zip Code:92225-1441
Practice Address - Country:US
Practice Address - Phone:760-574-5683
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-11
Last Update Date:2011-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program