Provider Demographics
NPI:1679352082
Name:MARTINEZ, AMELIA
Entity type:Individual
Prefix:
First Name:AMELIA
Middle Name:
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 1:563 W 24TH ST APT 6
Mailing Address - Street 2:
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84401-1260
Mailing Address - Country:US
Mailing Address - Phone:801-564-2946
Mailing Address - Fax:
Practice Address - Street 1:563 W 24TH ST APT 6
Practice Address - Street 2:
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84401-1260
Practice Address - Country:US
Practice Address - Phone:801-564-2946
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-25
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician