Healthcare Provider Details

I. General information

NPI: 1083135776
Provider Name (Legal Business Name): BRIAN MARTINEZ PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2017
Last Update Date: 06/10/2025
Certification Date: 06/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 N BRENT ST STE 301
VENTURA CA
93003-2836
US

IV. Provider business mailing address

1688 HARPER DR
VENTURA CA
93004-3035
US

V. Phone/Fax

Practice location:
  • Phone: 805-653-0101
  • Fax: 805-641-0434
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number54602
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: