Healthcare Provider Details

I. General information

NPI: 1548107097
Provider Name (Legal Business Name): AIDA MARTINEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/01/2026
Last Update Date: 05/01/2026
Certification Date: 05/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 E CESAR E CHAVEZ AVE
LOS ANGELES CA
90033-2464
US

IV. Provider business mailing address

3412 FLORAL DR
LOS ANGELES CA
90063-4110
US

V. Phone/Fax

Practice location:
  • Phone: 323-987-1309
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberNP95038331
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: