Healthcare Provider Details

I. General information

NPI: 1689342727
Provider Name (Legal Business Name): ASHLEY MARIE MARTINEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2021
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7250 WIEST RD
CALIPATRIA CA
92233-9604
US

IV. Provider business mailing address

PO BOX 26633
SAN DIEGO CA
92196-0633
US

V. Phone/Fax

Practice location:
  • Phone: 760-339-4992
  • Fax: 760-457-2645
Mailing address:
  • Phone: 760-554-8580
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: