Healthcare Provider Details

I. General information

NPI: 1912378746
Provider Name (Legal Business Name): MARTHA E MARTINEZ BSN, CDE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/20/2015
Last Update Date: 10/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 4TH AVE
SAN DIEGO CA
92101-2303
US

IV. Provider business mailing address

2001 4TH AVE
SAN DIEGO CA
92101-2303
US

V. Phone/Fax

Practice location:
  • Phone: 858-499-2600
  • Fax:
Mailing address:
  • Phone: 858-499-2600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License NumberRN375722
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: