Healthcare Provider Details

I. General information

NPI: 1649804683
Provider Name (Legal Business Name): LAICA JEAN MARTE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2020
Last Update Date: 01/05/2026
Certification Date: 01/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9837 FOLSOM BLVD STE F
SACRAMENTO CA
95827-1356
US

IV. Provider business mailing address

3800 WATT AVE STE 110
SACRAMENTO CA
95821-2622
US

V. Phone/Fax

Practice location:
  • Phone: 916-450-2600
  • Fax:
Mailing address:
  • Phone: 916-344-0249
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberMPSS-PDLTGR
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: