Healthcare Provider Details

I. General information

NPI: 1932093127
Provider Name (Legal Business Name): ANITTA MARTINEZ FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2025
Last Update Date: 07/08/2025
Certification Date: 07/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1035 PLACER ST
REDDING CA
96001-1170
US

IV. Provider business mailing address

4680 RED BLUFF ST
SHASTA LAKE CA
96019-9606
US

V. Phone/Fax

Practice location:
  • Phone: 530-246-5710
  • Fax:
Mailing address:
  • Phone: 530-215-5201
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number697354
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number95035820
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: