Healthcare Provider Details

I. General information

NPI: 1710745914
Provider Name (Legal Business Name): MARENA MARTINEZ KUTSCHMAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/12/2024
Last Update Date: 07/31/2025
Certification Date: 07/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

USS ESSEX (LHD2)
FPO AP
96643-1661
US

IV. Provider business mailing address

34800 BOB WILSON DR
SAN DIEGO CA
92134-5000
US

V. Phone/Fax

Practice location:
  • Phone: 619-556-4768
  • Fax:
Mailing address:
  • Phone: 360-720-4339
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number0101286762
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: