Healthcare Provider Details

I. General information

NPI: 1699095695
Provider Name (Legal Business Name): CATALINA MARTINEZ R.D.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2010
Last Update Date: 06/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13716 SHERMAN WAY
VAN NUYS CA
91405-2626
US

IV. Provider business mailing address

11107 ARMINTA ST UNIT 1
SUN VALLEY CA
91352-4489
US

V. Phone/Fax

Practice location:
  • Phone: 818-988-2020
  • Fax:
Mailing address:
  • Phone: 818-764-7235
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code126800000X
TaxonomyDental Assistant
License Number75718
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: