Healthcare Provider Details

I. General information

NPI: 1598456774
Provider Name (Legal Business Name): ADRIANA CRISTAL MARTINEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2023
Last Update Date: 05/17/2023
Certification Date: 05/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1935 N ST
NEWMAN CA
95360-1419
US

IV. Provider business mailing address

1935 N ST
NEWMAN CA
95360-1419
US

V. Phone/Fax

Practice location:
  • Phone: 209-862-1208
  • Fax: 209-862-2102
Mailing address:
  • Phone: 209-862-1208
  • Fax: 209-862-2102

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number165418
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: