Provider Demographics
NPI:1083445217
Name:MARTINEZ PENA, CESAR (CMT)
Entity type:Individual
Prefix:
First Name:CESAR
Middle Name:
Last Name:MARTINEZ PENA
Suffix:
Gender:M
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5315 WHITE OAK AVE UNIT J
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91316-4533
Mailing Address - Country:US
Mailing Address - Phone:818-481-4191
Mailing Address - Fax:
Practice Address - Street 1:5315 WHITE OAK AVE UNIT J
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91316-4533
Practice Address - Country:US
Practice Address - Phone:818-481-4191
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-09
Last Update Date:2024-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA72120225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist