Provider Demographics
NPI:1962868653
Name:MARTINEZ, DAVID A (PHD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:A
Last Name:MARTINEZ
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2130 FULTON ST
Mailing Address - Street 2:USF SCHOOL OF NURSING AND HEALTH PROFESSIONS
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94117-1080
Mailing Address - Country:US
Mailing Address - Phone:415-422-4247
Mailing Address - Fax:
Practice Address - Street 1:2130 FULTON ST
Practice Address - Street 2:USF SCHOOL OF NURSING AND HEALTH PROFESSIONS
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94117-1080
Practice Address - Country:US
Practice Address - Phone:415-422-4247
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-11
Last Update Date:2016-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY27559103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical