Provider Demographics
NPI:1932345808
Name:MARTINEZ, VIVIAN M (RN)
Entity type:Individual
Prefix:MS
First Name:VIVIAN
Middle Name:M
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 BONSALL AVE
Mailing Address - Street 2:
Mailing Address - City:ALDAN
Mailing Address - State:PA
Mailing Address - Zip Code:19018-3823
Mailing Address - Country:US
Mailing Address - Phone:610-809-2530
Mailing Address - Fax:
Practice Address - Street 1:13 BONSALL AVE
Practice Address - Street 2:
Practice Address - City:ALDAN
Practice Address - State:PA
Practice Address - Zip Code:19018-3823
Practice Address - Country:US
Practice Address - Phone:610-809-2530
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-26
Last Update Date:2008-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN548363253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care