Active NPI
Tiffany Rose Nicole Martinez, LPT
- Licensed Psychiatric Technician
- Fresno, CA
National Provider Identifier
1821242744
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Licensed Psychiatric Technician
- License
- 34123
- Practice address
- 3707 E Shields Ave
Fresno, CA 93726-7029 - Phone
- (559) 229-9040
- Fax
- (559) 229-9060
- NPI assigned
- Nov 5, 2008
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | PT 34123 | CA | |
| Licensed Psychiatric Technician | 167G00000X | 34123 | CA | Primary |
Addresses
Primary practice location
3707 E Shields Ave
Fresno, CA 93726-7029
Mailing address
3707 E Shields Ave
Fresno, CA 93726-7029
Phone (559) 229-9040
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PT 34123 | CA | MD | Addiction (Substance Use Disorder) Counselor |
| 34123 | CA | MD | Registered Respiratory Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1225843200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1610323200000",
"number": "1821242744",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3707 E SHIELDS AVE",
"city": "FRESNO",
"state": "CA",
"postal_code": "937267029",
"telephone_number": "559-229-9040",
"fax_number": "559-229-9060"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3707 E SHIELDS AVE",
"city": "FRESNO",
"state": "CA",
"postal_code": "937267029",
"telephone_number": "559-229-9040",
"fax_number": "559-229-9060"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MARTINEZ",
"first_name": "TIFFANY",
"middle_name": "ROSE NICOLE",
"credential": "LPT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-11-05",
"last_updated": "2021-01-11",
"certification_date": "2021-01-11",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "CA",
"license": "PT 34123",
"primary": false
},
{
"code": "167G00000X",
"taxonomy_group": "",
"desc": "Licensed Psychiatric Technician",
"state": "CA",
"license": "34123",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fresno, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 11, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.