Provider Demographics
NPI:1720339666
Name:MARTINEZ, CONSUELO CONNIE (RASI)
Entity type:Individual
Prefix:MS
First Name:CONSUELO
Middle Name:CONNIE
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:RASI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:730 21ST ST
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93301-2913
Mailing Address - Country:US
Mailing Address - Phone:661-829-5930
Mailing Address - Fax:661-427-0386
Practice Address - Street 1:730 21ST ST
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93301-2913
Practice Address - Country:US
Practice Address - Phone:661-829-5930
Practice Address - Fax:661-427-0386
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-01
Last Update Date:2012-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARI-M1209061742OtherRAS