Healthcare Provider Details

I. General information

NPI: 1174438451
Provider Name (Legal Business Name): JENNIFER JANNETH MARTINEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2026
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 S FREMONT AVE UNIT 20
ALHAMBRA CA
91803-8840
US

IV. Provider business mailing address

4051 1/2 S NORMANDIE AVE
LOS ANGELES CA
90037-1793
US

V. Phone/Fax

Practice location:
  • Phone: 626-349-3838
  • Fax:
Mailing address:
  • Phone: 213-414-4486
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: