Healthcare Provider Details

I. General information

NPI: 1104720713
Provider Name (Legal Business Name): CISNE MARTINEZ LVN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2026
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

407 W 103RD ST
LOS ANGELES CA
90003-4405
US

IV. Provider business mailing address

1732 AVIATION BLVD # 612
REDONDO BEACH CA
90278-2810
US

V. Phone/Fax

Practice location:
  • Phone: 213-293-3213
  • Fax:
Mailing address:
  • Phone: 213-293-3213
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number738112
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: