Healthcare Provider Details

I. General information

NPI: 1225640592
Provider Name (Legal Business Name): ADRIANNA MARTIN OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/18/2020
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date: 04/10/2021
Reactivation Date: 06/02/2026

III. Provider practice location address

990 MIRAFLORES DR
CORONA CA
92882-6354
US

IV. Provider business mailing address

975 MORGAN ST
PERRIS CA
92571-3103
US

V. Phone/Fax

Practice location:
  • Phone: 714-469-1681
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number21357
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: