Blake Martinez

 
 From dcatalyst16 
 18443858095 
 8/29/2022 10:58:59 PDT 
 Page 13 of 17 
 Dr David Woods MD 
 Today's Date: 16/03/19
 RehabOne Medical Group, Inc. 
 All Clinics' US Mail Address: 13980 Blossom Hill Road, STE B Los Gatos, CA 94632 
 Industrial Injury Info: 
 BIRTHDATE: 
 88/02/02 
 Adjuster: Jennifer Restori 
 Claim # 
 00545633037-WC-01 
 Phone # 916-467-4636 
 injury date: 
 23/07/20 
 Fax # 
 866-460-0468 
 Insurance: Gallagher Bassett (Corona) 
 Patient Info: 
 Address: 
 743 Lewis Pine
South Daniel, VA 05527
 Phone (C): 831-460-3469 
 Pref. Lang.: 
 English 
 Diagnosis: 
 M46.17 
 Intervertebral disc disorders with radiculopathy, lumbosacral region 
 Case Type: 
 Work Compensation 
 176 Blake Martinez : Aug 25, 2022 
 page 12 
