Healthcare Provider Details

I. General information

NPI: 1104193028
Provider Name (Legal Business Name): MRS. RUTH REBECCA MARTINEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2011
Last Update Date: 01/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8141 E KAISER BLVD STE 100
ANAHEIM CA
92808-2240
US

IV. Provider business mailing address

8141 E KAISER BLVD STE 100
ANAHEIM CA
92808-2240
US

V. Phone/Fax

Practice location:
  • Phone: 714-202-2101
  • Fax: 714-685-2124
Mailing address:
  • Phone: 714-202-2101
  • Fax: 714-685-2124

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2470A2800X
TaxonomyAssistant Health Information Record Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: