Provider Demographics
NPI:1174768816
Name:MARTINEZ, ALBERTO (MD)
Entity type:Individual
Prefix:DR
First Name:ALBERTO
Middle Name:
Last Name:MARTINEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:850 FIFTH ST
Mailing Address - Street 2:
Mailing Address - City:GONZALES
Mailing Address - State:CA
Mailing Address - Zip Code:93926
Mailing Address - Country:US
Mailing Address - Phone:831-675-3601
Mailing Address - Fax:831-675-3966
Practice Address - Street 1:850 FIFTH ST
Practice Address - Street 2:
Practice Address - City:GONZALES
Practice Address - State:CA
Practice Address - Zip Code:93926
Practice Address - Country:US
Practice Address - Phone:831-675-3601
Practice Address - Fax:831-675-3966
Is Sole Proprietor?:No
Enumeration Date:2008-12-09
Last Update Date:2015-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN49096207Q00000X
CAA136334207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1530319Medicaid