Provider Demographics
NPI:1962138081
Name:MARTINEZ, NADINE MELANIE
Entity type:Individual
Prefix:
First Name:NADINE
Middle Name:MELANIE
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 1:5870 EL CAMINO REAL UNIT 101
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92008-8816
Mailing Address - Country:US
Mailing Address - Phone:760-539-5818
Mailing Address - Fax:
Practice Address - Street 1:208 ARDYS PL
Practice Address - Street 2:
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92084-5118
Practice Address - Country:US
Practice Address - Phone:626-607-5445
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-29
Last Update Date:2022-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician