MEDICARE: STACI LYNN 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
1	163W00000X	Registered Nurse	95321628	CA
2	367500000X	Certified Registered Nurse Anesthetist	95002202	CA
3	367500000X	Certified Registered Nurse Anesthetist	1-205971	AL

General Provider Information

NPI Number	:	1790490936
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STACI LYNN MARTINEZ

Provider Business Mailing Address
First Line	:	27258 RED WILLOW CT
Second Line	:
City	:	VALENCIA
State	:	CA
Zip	:	91381-2171
Country	:	US
Telephone Number	:	310-433-3324
Fax Number	:

Provider Business Practice Location Address
First Line	:	400 N PEPPER AVE
Second Line	:
City	:	COLTON
State	:	CA
Zip	:	92324-1819
Country	:	US
Telephone Number	:	909-580-1000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/23/2023
Last Update Date	:	01/08/2026

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Directions to “ STACI LYNN MARTINEZ ” Practice Location

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