Healthcare Provider Details

I. General information

NPI: 1821906603
Provider Name (Legal Business Name): ELLIE JAYE MARTIN-CORONA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2026
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7225 N 1ST ST
FRESNO CA
93720-2986
US

IV. Provider business mailing address

5180 N PRIMITIVO WAY APT 355
FRESNO CA
93710-8261
US

V. Phone/Fax

Practice location:
  • Phone: 888-209-8805
  • Fax:
Mailing address:
  • Phone: 661-889-0353
  • Fax:

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: