Healthcare Provider Details

I. General information

NPI: 1003141607
Provider Name (Legal Business Name): OCTAVIANA MARTINEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: OCTAVIANIA RODRIGUEZ

II. Dates (important events)

Enumeration Date: 10/15/2009
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4411 E CESAR CHAVEZ BLVD
FRESNO CA
93702-3604
US

IV. Provider business mailing address

4411 E CESAR CHAVEZ BLVD
FRESNO CA
93702-3604
US

V. Phone/Fax

Practice location:
  • Phone: 559-600-7180
  • Fax:
Mailing address:
  • Phone: 559-600-7180
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number756244
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: