Healthcare Provider Details

I. General information

NPI: 1649667379
Provider Name (Legal Business Name): ASHLEY RAE MARTINEZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2015
Last Update Date: 11/25/2020
Certification Date: 11/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

625 CITRACADO PKWY STE 200
ESCONDIDO CA
92025-6428
US

IV. Provider business mailing address

625 CITRACADO PKWY STE 200
ESCONDIDO CA
92025-6428
US

V. Phone/Fax

Practice location:
  • Phone: 760-746-2641
  • Fax: 760-740-2178
Mailing address:
  • Phone: 760-746-2641
  • Fax: 760-740-2178

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA146820
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: