Provider Demographics
NPI:1295449718
Name:MURRIETA-MARTINEZ, ANGIE MONIQUE
Entity type:Individual
Prefix:
First Name:ANGIE
Middle Name:MONIQUE
Last Name:MURRIETA-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 1:3700 W MINERAL KING AVE
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93291-5531
Mailing Address - Country:US
Mailing Address - Phone:559-825-8455
Mailing Address - Fax:
Practice Address - Street 1:3700 W MINERAL KING AVE
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93291-5531
Practice Address - Country:US
Practice Address - Phone:559-825-8455
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-09
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst