Healthcare Provider Details

I. General information

NPI: 1336833102
Provider Name (Legal Business Name): XIOMARA A MARTINEZ RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2023
Last Update Date: 06/05/2023
Certification Date: 06/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34800 BOB WILSON DR
SAN DIEGO CA
92134-1098
US

IV. Provider business mailing address

44674 ARBOR LN
TEMECULA CA
92592-5859
US

V. Phone/Fax

Practice location:
  • Phone: 619-532-9000
  • Fax:
Mailing address:
  • Phone: 917-471-6131
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95144648
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License Number95144648
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License Number95144648
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number554573
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: