Provider Demographics
NPI:1063727097
Name:MARTIR, ROXANNE K
Entity type:Individual
Prefix:
First Name:ROXANNE
Middle Name:K
Last Name:MARTIR
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 1:26891 SPRING ST
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN CAPO
Mailing Address - State:CA
Mailing Address - Zip Code:92675-2692
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:26891 SPRING ST
Practice Address - Street 2:
Practice Address - City:SAN JUAN CAPO
Practice Address - State:CA
Practice Address - Zip Code:92675-2692
Practice Address - Country:US
Practice Address - Phone:949-496-2931
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-14
Last Update Date:2010-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical