Doctor Name: | CASEY DANELE MARTINEZ |
NPI Number: | 1366792848 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | LP047299 |
Business Practice Address: | 7301 N 58th Ave Glendale, AZ - 853011867 |
Business Phone Number: | 6232374110 |
Business Fax Number: | 6232374115 |
Mailing Address: | 7301 N 58th Ave, GLENDALE |
State: | AZ |
Postal Code: | 853011867 |
Phone Number: | 6232374110 |
Fax Number: | 6232374115 |
NPI Enumeration Date: | 09/12/2012 |
NPI Last Update Date: | 09/12/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 390200000X |
License Number: | LP047299 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | AZ |
Taxonomy Type: | Student, Health Care |
Taxonomy Classification: | Student in an Organized Health Care Education/Training Program |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. |