Healthcare Provider Details

I. General information

NPI: 1164009783
Provider Name (Legal Business Name): MELANIE ROSE MARTINEZ NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2021
Last Update Date: 03/28/2021
Certification Date: 03/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1140 W LA VETA AVE STE 805
ORANGE CA
92868-4229
US

IV. Provider business mailing address

1140 W LA VETA AVE STE 805
ORANGE CA
92868-4229
US

V. Phone/Fax

Practice location:
  • Phone: 714-744-8661
  • Fax: 714-744-8692
Mailing address:
  • Phone: 714-744-8661
  • Fax: 714-744-8692

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number95016929
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: