Healthcare Provider Details

I. General information

NPI: 1366573958
Provider Name (Legal Business Name): ALMA MARTINEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/08/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 S 7TH AVE
LA PUENTE CA
91746-3211
US

IV. Provider business mailing address

160 S 7TH AVE
LA PUENTE CA
91746-3211
US

V. Phone/Fax

Practice location:
  • Phone: 626-961-8971
  • Fax: 626-961-6685
Mailing address:
  • Phone: 626-961-8971
  • Fax: 626-961-6685

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License NumberNONE
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: