Provider Demographics
NPI:1194314161
Name:MARTINEZ, ALEX JR
Entity type:Individual
Prefix:
First Name:ALEX
Middle Name:
Last Name:MARTINEZ
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3961 VIA MARISOL APT 203
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90042-5076
Mailing Address - Country:US
Mailing Address - Phone:619-495-6052
Mailing Address - Fax:
Practice Address - Street 1:3961 VIA MARISOL
Practice Address - Street 2:APT 203
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90042-5076
Practice Address - Country:US
Practice Address - Phone:619-495-6052
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-14
Last Update Date:2022-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA299412225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist