Healthcare Provider Details

I. General information

NPI: 1487495636
Provider Name (Legal Business Name): JENNIFER MARTINEZ PPS, LEP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/03/2024
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3708 COFFEE RD STE D
BAKERSFIELD CA
93308-5235
US

IV. Provider business mailing address

1500 S FAIRFAX RD
BAKERSFIELD CA
93307-3199
US

V. Phone/Fax

Practice location:
  • Phone: 661-379-7977
  • Fax:
Mailing address:
  • Phone: 310-626-2802
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TM1800X
TaxonomyIntellectual & Developmental Disabilities Psychologist
License Number4157
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number4157
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: