Healthcare Provider Details

I. General information

NPI: 1144184474
Provider Name (Legal Business Name): NICHOLAS CORNADO MARTINEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2025
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

177 W HENDERSON AVE STE 4
PORTERVILLE CA
93257-1777
US

IV. Provider business mailing address

177 W HENDERSON AVE STE 4
PORTERVILLE CA
93257-1777
US

V. Phone/Fax

Practice location:
  • Phone: 559-977-3089
  • Fax:
Mailing address:
  • Phone: 559-977-3089
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: