Healthcare Provider Details

I. General information

NPI: 1760779433
Provider Name (Legal Business Name): OLIVIA MARTINEZ AGUILAR NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2011
Last Update Date: 07/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1629 W 17TH ST STE A
SANTA ANA CA
92706-3335
US

IV. Provider business mailing address

2365 MEDLAR RD
TUSTIN CA
92780-6820
US

V. Phone/Fax

Practice location:
  • Phone: 714-972-2111
  • Fax: 714-972-2045
Mailing address:
  • Phone: 714-730-9674
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number356907
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number356907
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code364SP0200X
TaxonomyPediatric Clinical Nurse Specialist
License Number356907
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: