Provider Demographics
NPI:1316449259
Name:MARTINEZ, JACQUELYN VELA (N/A)
Entity type:Individual
Prefix:
First Name:JACQUELYN
Middle Name:VELA
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:N/A
Other - Prefix:MS
Other - First Name:JACKIE
Other - Middle Name:VELA
Other - Last Name:MARTINEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:N/A
Mailing Address - Street 1:5820 STONERIDGE MALL RD STE 205
Mailing Address - Street 2:
Mailing Address - City:PLEASANTON
Mailing Address - State:CA
Mailing Address - Zip Code:94588-3347
Mailing Address - Country:US
Mailing Address - Phone:877-418-2978
Mailing Address - Fax:866-500-2186
Practice Address - Street 1:5363 N FRESNO ST STE 105
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93710-6848
Practice Address - Country:US
Practice Address - Phone:559-696-4891
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-07
Last Update Date:2018-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician