Healthcare Provider Details

I. General information

NPI: 1538076815
Provider Name (Legal Business Name): CAROLINA GUADALUPE MARTIN RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2026
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1163 W GRAND AVE
GROVER BEACH CA
93433-2149
US

IV. Provider business mailing address

247 OLIVOS LN
NIPOMO CA
93444-9543
US

V. Phone/Fax

Practice location:
  • Phone: 805-904-6979
  • Fax:
Mailing address:
  • Phone: 661-480-3295
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number32225
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: