Provider Demographics
NPI:1487385100
Name:MARTINEZ, MILADYS N/A
Entity type:Individual
Prefix:
First Name:MILADYS
Middle Name:N/A
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 1:4251 S HIGUERA ST STE 300
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401-7741
Mailing Address - Country:US
Mailing Address - Phone:805-710-0730
Mailing Address - Fax:
Practice Address - Street 1:4251 S HIGUERA ST STE 300
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-7741
Practice Address - Country:US
Practice Address - Phone:805-548-0606
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-22
Last Update Date:2022-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95067247163W00000X
CA659176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA95067247OtherREGISTERED NURSE
CA659OtherLICENSED MIDWIFE