Healthcare Provider Details

I. General information

NPI: 1609444744
Provider Name (Legal Business Name): XIOMARA REYES MARTINEZ AA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2021
Last Update Date: 06/15/2021
Certification Date: 06/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2125 CITRACADO PKWY STE 200
ESCONDIDO CA
92029-4159
US

IV. Provider business mailing address

2011 WEATHERVANE AVE
ESCONDIDO CA
92027-3735
US

V. Phone/Fax

Practice location:
  • Phone: 760-294-9270
  • Fax: 760-294-9268
Mailing address:
  • Phone: 760-802-9486
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: