Provider Demographics
NPI:1447076401
Name:MARTINEZ, CERTIFIED CASE MANAGER, JUAN ANTONIO (ABH CASE MANAGER)
Entity type:Individual
Prefix:
First Name:JUAN
Middle Name:ANTONIO
Last Name:MARTINEZ, CERTIFIED CASE MANAGER
Suffix:
Gender:M
Credentials:ABH CASE MANAGER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:390 W 175 S
Mailing Address - Street 2:
Mailing Address - City:KAYSVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84037-1865
Mailing Address - Country:US
Mailing Address - Phone:385-250-6623
Mailing Address - Fax:
Practice Address - Street 1:845 W 200 N
Practice Address - Street 2:
Practice Address - City:KAYSVILLE
Practice Address - State:UT
Practice Address - Zip Code:84037-2406
Practice Address - Country:US
Practice Address - Phone:801-513-5132
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-25
Last Update Date:2024-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator