Healthcare Provider Details

I. General information

NPI: 1821923806
Provider Name (Legal Business Name): JESSICA EILEEN MARTINEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2026
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1450 SAN PABLO ST STE 3600
LOS ANGELES CA
90033-5332
US

IV. Provider business mailing address

1450 SAN PABLO ST STE 3600
LOS ANGELES CA
90033-5332
US

V. Phone/Fax

Practice location:
  • Phone: 818-357-0012
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number95002892
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: