Healthcare Provider Details

I. General information

NPI: 1063129351
Provider Name (Legal Business Name): ASHLEY NICOLE MARTIGNONI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/04/2022
Last Update Date: 11/10/2022
Certification Date: 11/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 ALESSANDRO PL STE 410
PASADENA CA
91105-3175
US

IV. Provider business mailing address

PO BOX 7991
PORTER RANCH CA
91327-7991
US

V. Phone/Fax

Practice location:
  • Phone: 626-793-7114
  • Fax:
Mailing address:
  • Phone: 818-730-9786
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95023175
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: