Provider Demographics
NPI:1205719200
Name:MARTINO, MARILYN JEAN
Entity type:Individual
Prefix:
First Name:MARILYN
Middle Name:JEAN
Last Name:MARTINO
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 1:19401 SUSAN WAY
Mailing Address - Street 2:
Mailing Address - City:SONORA
Mailing Address - State:CA
Mailing Address - Zip Code:95370-9266
Mailing Address - Country:US
Mailing Address - Phone:209-588-7018
Mailing Address - Fax:
Practice Address - Street 1:22409 YERBA SANTA DR
Practice Address - Street 2:19401 SUSAN WAY
Practice Address - City:SONORA
Practice Address - State:CA
Practice Address - Zip Code:95370-9537
Practice Address - Country:US
Practice Address - Phone:209-588-7040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-28
Last Update Date:2025-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care