Healthcare Provider Details

I. General information

NPI: 1588195655
Provider Name (Legal Business Name): HEIDI MARTINEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/21/2017
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

306 WALNUT AVE STE 32
SAN DIEGO CA
92103-4936
US

IV. Provider business mailing address

306 WALNUT AVE STE 32
SAN DIEGO CA
92103-4936
US

V. Phone/Fax

Practice location:
  • Phone: 623-872-5316
  • Fax:
Mailing address:
  • Phone: 619-204-5843
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number95016675
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP9996
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: