Provider Demographics
NPI:1760200257
Name:MARTIN, ALISHA (HEALTH COACH FMP)
Entity type:Individual
Prefix:
First Name:ALISHA
Middle Name:
Last Name:MARTIN
Suffix:
Gender:F
Credentials:HEALTH COACH FMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16805 S 45TH PL
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85048-7033
Mailing Address - Country:US
Mailing Address - Phone:480-650-9261
Mailing Address - Fax:
Practice Address - Street 1:16805 S 45TH PL
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85048-7033
Practice Address - Country:US
Practice Address - Phone:480-650-9261
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-02
Last Update Date:2024-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ59016146L00000X
174H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator
No146L00000XEmergency Medical Service ProvidersEmergency Medical Technician, Paramedic