Healthcare Provider Details

I. General information

NPI: 1548664022
Provider Name (Legal Business Name): CRISTIAN MARTINEZ FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CRISTIAN VARGAS

II. Dates (important events)

Enumeration Date: 10/13/2014
Last Update Date: 05/16/2025
Certification Date: 05/16/2025
Deactivation Date: 11/23/2016
Reactivation Date: 01/09/2025

III. Provider practice location address

51544 CESAR CHAVEZ ST STE 1D
COACHELLA CA
92236-1504
US

IV. Provider business mailing address

51544 CESAR CHAVEZ ST
COACHELLA CA
92236-1501
US

V. Phone/Fax

Practice location:
  • Phone: 760-861-1436
  • Fax:
Mailing address:
  • Phone: 760-861-1436
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95035083
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: