Provider Demographics
NPI:1144976267
Name:MARTINEZ, CATERINE MICHELLE
Entity type:Individual
Prefix:
First Name:CATERINE
Middle Name:MICHELLE
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 1:9701 DINO DR
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95624-4025
Mailing Address - Country:US
Mailing Address - Phone:916-892-0013
Mailing Address - Fax:
Practice Address - Street 1:13510 MONTFORT AVE
Practice Address - Street 2:
Practice Address - City:HERALD
Practice Address - State:CA
Practice Address - Zip Code:95638-9761
Practice Address - Country:US
Practice Address - Phone:916-420-5383
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-28
Last Update Date:2022-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA96374100EMedicaid