Healthcare Provider Details

I. General information

NPI: 1881561819
Provider Name (Legal Business Name): MIREYA AGAMA MARTINEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/23/2025
Last Update Date: 10/23/2025
Certification Date: 10/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

725 E MAIN ST
SANTA PAULA CA
93060-2748
US

IV. Provider business mailing address

PO BOX 7294
OXNARD CA
93031-7294
US

V. Phone/Fax

Practice location:
  • Phone: 805-525-1618
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: