Healthcare Provider Details

I. General information

NPI: 1457520637
Provider Name (Legal Business Name): MARSHA MARTINEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2008
Last Update Date: 08/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

740 S PLACENTIA AVE STE 100
PLACENTIA CA
92870
US

IV. Provider business mailing address

740 S PLACENTIA AVE
PLACENTIA CA
92870-6832
US

V. Phone/Fax

Practice location:
  • Phone: 714-646-8318
  • Fax:
Mailing address:
  • Phone: 714-646-8318
  • Fax: 714-646-8320

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number4409
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: