Healthcare Provider Details

I. General information

NPI: 1831942564
Provider Name (Legal Business Name): ELISA MARIE MARTINEZ NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/11/2024
Last Update Date: 07/30/2025
Certification Date: 07/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7117 BROCKTON AVE
RIVERSIDE CA
92506-2658
US

IV. Provider business mailing address

3660 ARLINGTON AVE
RIVERSIDE CA
92506-3987
US

V. Phone/Fax

Practice location:
  • Phone: 951-321-6354
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number95029741
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number95029741
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: