Provider Demographics
NPI:1932939303
Name:MARTINEZ, JAIME (PPS)
Entity type:Individual
Prefix:MRS
First Name:JAIME
Middle Name:
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:PPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10704 BLUE CREST RD
Mailing Address - Street 2:
Mailing Address - City:YUCAIPA
Mailing Address - State:CA
Mailing Address - Zip Code:92399-5926
Mailing Address - Country:US
Mailing Address - Phone:909-844-6624
Mailing Address - Fax:
Practice Address - Street 1:10704 BLUE CREST RD
Practice Address - Street 2:
Practice Address - City:YUCAIPA
Practice Address - State:CA
Practice Address - Zip Code:92399-5926
Practice Address - Country:US
Practice Address - Phone:909-844-6624
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-01
Last Update Date:2024-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool