Provider Demographics
NPI:1285077370
Name:ANGEL MARTINEZ, LAURA JANET
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:JANET
Last Name:ANGEL MARTINEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:JANET
Other - Last Name:MARTINEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:245 S HUMBOLDT ST APT B
Mailing Address - Street 2:
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94401-2983
Mailing Address - Country:US
Mailing Address - Phone:503-156-6085
Mailing Address - Fax:
Practice Address - Street 1:225 37TH AVE
Practice Address - Street 2:THIRD FLOOR
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94403-4324
Practice Address - Country:US
Practice Address - Phone:650-573-2639
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-09
Last Update Date:2024-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
No175T00000XOther Service ProvidersPeer Specialist