Healthcare Provider Details

I. General information

NPI: 1588592489
Provider Name (Legal Business Name): CLARA LUZ ESPERANZA MARTIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2026
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

306 E MAIN ST
STOCKTON CA
95202-2941
US

IV. Provider business mailing address

306 E MAIN ST
STOCKTON CA
95202-2941
US

V. Phone/Fax

Practice location:
  • Phone: 209-478-4554
  • Fax: 209-478-1991
Mailing address:
  • Phone: 209-478-4554
  • Fax: 209-478-1991

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: