Provider Demographics
NPI:1417764515
Name:MARTINEZ, VERONYKA MARIE
Entity type:Individual
Prefix:
First Name:VERONYKA
Middle Name:MARIE
Last Name:MARTINEZ
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:VERONYKA
Other - Middle Name:PHEBE MARIE
Other - Last Name:WELLS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:731 HAUSTEN ST APT 6
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96826-3076
Mailing Address - Country:US
Mailing Address - Phone:707-227-6772
Mailing Address - Fax:
Practice Address - Street 1:731 HAUSTEN ST APT 6
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96826-3076
Practice Address - Country:US
Practice Address - Phone:707-227-6772
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-12
Last Update Date:2025-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician