Provider Demographics
NPI:1093517500
Name:SISNEROZ, MARTIN JR
Entity type:Individual
Prefix:
First Name:MARTIN
Middle Name:
Last Name:SISNEROZ
Suffix:JR
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1738 BARTLETT CT
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95206-6358
Mailing Address - Country:US
Mailing Address - Phone:559-250-1121
Mailing Address - Fax:
Practice Address - Street 1:229 E WEBER AVE STE 102
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95202-2712
Practice Address - Country:US
Practice Address - Phone:559-250-1121
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-25
Last Update Date:2025-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator