Healthcare Provider Details

I. General information

NPI: 1740770320
Provider Name (Legal Business Name): LETICIA FLORES MARTINEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2018
Last Update Date: 04/26/2021
Certification Date: 04/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12975 BROOKPRINTER PL STE 250
POWAY CA
92064-8894
US

IV. Provider business mailing address

425 BRADLEY ST APT 141
EL CAJON CA
92021
US

V. Phone/Fax

Practice location:
  • Phone: 858-842-3930
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: