Healthcare Provider Details

I. General information

NPI: 1194124610
Provider Name (Legal Business Name): JAMES MARTINEZ SRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/20/2014
Last Update Date: 10/04/2021
Certification Date: 10/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2905 PYRENEES DR
ALHAMBRA CA
91803-2620
US

IV. Provider business mailing address

2905 PYRENEES DR
ALHAMBRA CA
91803-2620
US

V. Phone/Fax

Practice location:
  • Phone: 626-524-8500
  • Fax:
Mailing address:
  • Phone: 626-524-8500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number95000186
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: