Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225400000X | Rehabilitation Practitioner |
NPI | 1013661784 |
---|---|
Provider Name | Jeanette Martinez |
First Address | Culver City, CA 90232-6824 |
Second Address | Culver City, CA 90232-6824 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/02/2022 |
Last Update Date | 10/02/2022 |