Provider Demographics
NPI:1285719542
Name:MARTINEZ, SHARON R (DC)
Entity type:Individual
Prefix:
First Name:SHARON
Middle Name:R
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10722 ARROW RTE
Mailing Address - Street 2:STE 610
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-4808
Mailing Address - Country:US
Mailing Address - Phone:909-483-5295
Mailing Address - Fax:909-483-5297
Practice Address - Street 1:10722 ARROW RTE
Practice Address - Street 2:STE 610
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-4808
Practice Address - Country:US
Practice Address - Phone:909-483-5295
Practice Address - Fax:909-483-5297
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2011-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21197111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0516626Medicaid
CA0516626Medicaid
CAU19445Medicare ID - Type Unspecified