Healthcare Provider Details

I. General information

NPI: 1144061623
Provider Name (Legal Business Name): HANNAH PAULINA MARTIN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/06/2024
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1364 N WATERMAN AVE
SAN BERNARDINO CA
92404-5313
US

IV. Provider business mailing address

PO BOX 310281
FONTANA CA
92331-0281
US

V. Phone/Fax

Practice location:
  • Phone: 909-688-6151
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberAMFT148468
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: