Provider Demographics
NPI:1316978760
Name:MARTINEZ, VICTOR M (CPED)
Entity type:Individual
Prefix:
First Name:VICTOR
Middle Name:M
Last Name:MARTINEZ
Suffix:
Gender:M
Credentials:CPED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3127 W 63RD ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60629-2719
Mailing Address - Country:US
Mailing Address - Phone:773-925-4184
Mailing Address - Fax:773-925-4134
Practice Address - Street 1:3127 W 63RD ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60629-2719
Practice Address - Country:US
Practice Address - Phone:773-925-4184
Practice Address - Fax:773-925-4134
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor