Provider Demographics
NPI:1144509936
Name:MARTINEZ, HALIE ACAS I (PROVIDER)
Entity type:Individual
Prefix:MR
First Name:HALIE
Middle Name:ACAS
Last Name:MARTINEZ
Suffix:I
Gender:M
Credentials:PROVIDER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 20457
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93390-0457
Mailing Address - Country:US
Mailing Address - Phone:661-444-4125
Mailing Address - Fax:
Practice Address - Street 1:5500 SILVER CROSSING ST
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93313-4124
Practice Address - Country:US
Practice Address - Phone:661-444-4125
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-10
Last Update Date:2011-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA121453343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA2231299OtherCA DRIVER LICENSE