Healthcare Provider Details

I. General information

NPI: 1013329093
Provider Name (Legal Business Name): ANA MARTINEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2014
Last Update Date: 05/27/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11111 STRATHERN ST APT 89
SUN VALLEY CA
91352-3969
US

IV. Provider business mailing address

11111 STRATHERN ST APT 89
SUN VALLEY CA
91352-3969
US

V. Phone/Fax

Practice location:
  • Phone: 818-804-6692
  • Fax:
Mailing address:
  • Phone: 818-804-6692
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code126800000X
TaxonomyDental Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: