Provider Demographics
NPI:1538752035
Name:MARTINEZ, JOSEPH (IDC STUDENT)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:
Last Name:MARTINEZ
Suffix:
Gender:M
Credentials:IDC STUDENT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7261 BIRCH CIR
Mailing Address - Street 2:
Mailing Address - City:PEARL CITY
Mailing Address - State:HI
Mailing Address - Zip Code:96782-4501
Mailing Address - Country:US
Mailing Address - Phone:760-277-4971
Mailing Address - Fax:
Practice Address - Street 1:MARINE CORPS BASE HAWAII (MCBH)
Practice Address - Street 2:BLDG 221
Practice Address - City:KAILUA
Practice Address - State:HI
Practice Address - Zip Code:96734-9678
Practice Address - Country:US
Practice Address - Phone:760-277-4971
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-16
Last Update Date:2021-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman