Healthcare Provider Details

I. General information

NPI: 1811510720
Provider Name (Legal Business Name): JULIE MARTINEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2020
Last Update Date: 05/27/2020
Certification Date: 05/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9745 LAUREL CANYON BLVD STE A
ARLETA CA
91331-4115
US

IV. Provider business mailing address

8523 BLANCHARD AVE
FONTANA CA
92335-3901
US

V. Phone/Fax

Practice location:
  • Phone: 818-435-3106
  • Fax:
Mailing address:
  • Phone: 909-749-2422
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code126800000X
TaxonomyDental Assistant
License Number81162
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: