Provider Demographics
NPI:1356022040
Name:MARTINEZ, ALEJANDRO GASTELLO (SOCIAL WORKER)
Entity type:Individual
Prefix:
First Name:ALEJANDRO
Middle Name:GASTELLO
Last Name:MARTINEZ
Suffix:
Gender:M
Credentials:SOCIAL WORKER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1814 CHAMBORD DR
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95210-2275
Mailing Address - Country:US
Mailing Address - Phone:209-689-1382
Mailing Address - Fax:
Practice Address - Street 1:5100 OBYRNES FERRY RD
Practice Address - Street 2:
Practice Address - City:JAMESTOWN
Practice Address - State:CA
Practice Address - Zip Code:95327-9102
Practice Address - Country:US
Practice Address - Phone:209-984-5291
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-26
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA41032167G00000X
CA113265390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No167G00000XNursing Service ProvidersLicensed Psychiatric Technician