Healthcare Provider Details

I. General information

NPI: 1417866203
Provider Name (Legal Business Name): VICTORIA LORENA MARTINEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2026
Last Update Date: 09/05/2026
Certification Date: 09/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2801 ATLANTIC AVE
LONG BEACH CA
90806-1701
US

IV. Provider business mailing address

703 S SHADYGLEN DR
COVINA CA
91724-3660
US

V. Phone/Fax

Practice location:
  • Phone: 562-933-9019
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number310109
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: