Provider Demographics
NPI:1861062283
Name:MARTINEZ, HALLIE ELISE
Entity type:Individual
Prefix:
First Name:HALLIE
Middle Name:ELISE
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 1:129 POLLASKY AVE APT 10
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93612-1165
Mailing Address - Country:US
Mailing Address - Phone:559-608-2009
Mailing Address - Fax:
Practice Address - Street 1:129 POLLASKY AVE APT 10
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:CA
Practice Address - Zip Code:93612-1165
Practice Address - Country:US
Practice Address - Phone:559-608-2009
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-28
Last Update Date:2021-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer