Provider Demographics
NPI:1891514022
Name:MARTINEZ, DANIELLE TARA
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:TARA
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1031 WATERLOO RD
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95205-4256
Mailing Address - Country:US
Mailing Address - Phone:209-940-5662
Mailing Address - Fax:
Practice Address - Street 1:1031 WATERLOO RD
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95205-4256
Practice Address - Country:US
Practice Address - Phone:209-940-5662
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-04
Last Update Date:2024-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator