Healthcare Provider Details

I. General information

NPI: 1447165717
Provider Name (Legal Business Name): BRIANNA MARTINEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2026
Last Update Date: 08/19/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

671 SAN JOSE CT
CHULA VISTA CA
91914-4044
US

IV. Provider business mailing address

671 SAN JOSE CT
CHULA VISTA CA
91914-4044
US

V. Phone/Fax

Practice location:
  • Phone: 619-753-4666
  • Fax: 440-291-8025
Mailing address:
  • Phone: 619-753-4666
  • Fax: 440-291-8025

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: