Healthcare Provider Details

I. General information

NPI: 1407386006
Provider Name (Legal Business Name): MARTHA MARTINEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2017
Last Update Date: 09/29/2026
Certification Date: 02/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1360 E LASSEN AVE
CHICO CA
95973-7823
US

IV. Provider business mailing address

1360 E LASSEN AVE
CHICO CA
95973-7823
US

V. Phone/Fax

Practice location:
  • Phone: 530-267-1753
  • Fax: 530-267-1775
Mailing address:
  • Phone: 530-267-1753
  • Fax: 530-267-1775

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number122833
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: