Provider Demographics
NPI:1447659776
Name:MARTINEZ, LUZ E
Entity type:Individual
Prefix:
First Name:LUZ
Middle Name:E
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 1:973 W 7TH ST APT C
Mailing Address - Street 2:SAN PEDRO
Mailing Address - City:SAN PEDRO
Mailing Address - State:CA
Mailing Address - Zip Code:90731-3075
Mailing Address - Country:US
Mailing Address - Phone:310-808-7494
Mailing Address - Fax:
Practice Address - Street 1:973 W 7TH ST APT C
Practice Address - Street 2:SAN PEDRO
Practice Address - City:SAN PEDRO
Practice Address - State:CA
Practice Address - Zip Code:90731-3075
Practice Address - Country:US
Practice Address - Phone:310-808-7494
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-22
Last Update Date:2014-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARDA65179126800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant