Provider Demographics
NPI:1154566263
Name:MARTINEZ, ATHENA DIONNE
Entity type:Individual
Prefix:
First Name:ATHENA
Middle Name:DIONNE
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 1:2758 DETROIT DR
Mailing Address - Street 2:
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93036-1784
Mailing Address - Country:US
Mailing Address - Phone:805-278-4323
Mailing Address - Fax:
Practice Address - Street 1:495 LAS PALOMAS DR
Practice Address - Street 2:
Practice Address - City:PORT HUENEME
Practice Address - State:CA
Practice Address - Zip Code:93041-1541
Practice Address - Country:US
Practice Address - Phone:805-985-2149
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-04
Last Update Date:2008-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health