Healthcare Provider Details

I. General information

NPI: 1104755743
Provider Name (Legal Business Name): IDALMIS MARTINEZ NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/19/2026
Last Update Date: 05/19/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10835 MOLETTE ST
NORWALK CA
90650-5438
US

IV. Provider business mailing address

10835 MOLETTE ST
NORWALK CA
90650-5438
US

V. Phone/Fax

Practice location:
  • Phone: 562-841-8207
  • Fax:
Mailing address:
  • Phone: 562-841-8207
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number95039585
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: