Healthcare Provider Details

I. General information

NPI: 1073861282
Provider Name (Legal Business Name): SOFIA MARIE MARTINEZ I A.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/20/2012
Last Update Date: 08/21/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21520 PIONEER BLVD
HAWAIIAN GARDENS CA
90716-2603
US

IV. Provider business mailing address

11430 MULLER ST
SANTA FE SPRINGS CA
90670-4328
US

V. Phone/Fax

Practice location:
  • Phone: 562-246-5700
  • Fax:
Mailing address:
  • Phone: 562-455-6519
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: