Healthcare Provider Details

I. General information

NPI: 1376256958
Provider Name (Legal Business Name): KRISTINA MONIQUE MARTINEZ CPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/29/2022
Last Update Date: 04/13/2023
Certification Date: 04/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1008 GIUSEPPE CT
BAKERSFIELD CA
93307-5572
US

IV. Provider business mailing address

1008 GIUSEPPE CT
BAKERSFIELD CA
93307-5572
US

V. Phone/Fax

Practice location:
  • Phone: 805-703-6316
  • Fax:
Mailing address:
  • Phone: 805-703-6316
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License Number01007451
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: