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NPI Code Detail

MEDICARE: JENNIFER MARIE MARTINEZ

MEDICARE: JENNIFER MARIE MARTINEZ
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YA0400XAddiction (Substance Use Disorder) CounselorRT1438520426CA

General Provider Information

NPI Number : 1063227502
Entity Type Code : Individual
Provider Name (Legal Business Name) : JENNIFER MARIE MARTINEZ
Provider Business Mailing Address
First Line : 1260 E ARROW HWY
Second Line :
City : UPLAND
State : CA
Zip : 91786-4982
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1260 E ARROW HWY
Second Line :
City : UPLAND
State : CA
Zip : 91786-4982
Country : US
Telephone Number : 909-932-1069
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/11/2025
Last Update Date : 04/06/2026

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Directions to “ JENNIFER MARIE MARTINEZ ” Practice Location

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