Healthcare Provider Details

I. General information

NPI: 1558288233
Provider Name (Legal Business Name): BRIANNA BALTAZAR-MARTINEZ RDA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/02/2026
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 S CHINOWTH ST STE 201
VISALIA CA
93277-1653
US

IV. Provider business mailing address

2431 W CLINTON AVE
VISALIA CA
93291-3137
US

V. Phone/Fax

Practice location:
  • Phone: 559-624-1177
  • Fax:
Mailing address:
  • Phone: 559-616-0430
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number63101
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: