Provider Demographics
NPI:1144997198
Name:MARTINEZ, DONNA (CMT)
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:613 N 41ST ST
Mailing Address - Street 2:
Mailing Address - City:BANNING
Mailing Address - State:CA
Mailing Address - Zip Code:92220-3413
Mailing Address - Country:US
Mailing Address - Phone:951-219-7007
Mailing Address - Fax:
Practice Address - Street 1:1055 E 6TH ST SPC 211
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:CA
Practice Address - Zip Code:92223-2363
Practice Address - Country:US
Practice Address - Phone:951-219-7007
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-26
Last Update Date:2021-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA35880225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist