Healthcare Provider Details

I. General information

NPI: 1316737059
Provider Name (Legal Business Name): KASSANDRA MARTINEZ-ACEVES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/07/2025
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6800 INDIANA AVE STE 150
RIVERSIDE CA
92506-4286
US

IV. Provider business mailing address

1254 ALLEGIANCE AVE
HEMET CA
92543-7354
US

V. Phone/Fax

Practice location:
  • Phone: 951-684-6684
  • Fax:
Mailing address:
  • Phone: 203-935-7073
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: