Healthcare Provider Details

I. General information

NPI: 1669128286
Provider Name (Legal Business Name): NATALY VERONICA MARTINEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/22/2022
Last Update Date: 03/01/2022
Certification Date: 03/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

812 BEACH AVE
CALEXICO CA
92231-2513
US

IV. Provider business mailing address

812 BEACH AVE
CALEXICO CA
92231-2513
US

V. Phone/Fax

Practice location:
  • Phone: 619-755-2485
  • Fax:
Mailing address:
  • Phone: 619-755-2485
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: