Healthcare Provider Details

I. General information

NPI: 1033027131
Provider Name (Legal Business Name): JAVIER JESUS MARTINEZ LVN/LPN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2026
Last Update Date: 08/31/2026
Certification Date: 08/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 GILMORE RD
RED BLUFF CA
96080-3500
US

IV. Provider business mailing address

10 GILMORE RD
RED BLUFF CA
96080-3500
US

V. Phone/Fax

Practice location:
  • Phone: 530-248-7755
  • Fax:
Mailing address:
  • Phone: 530-248-7755
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number749867
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: