Healthcare Provider Details

I. General information

NPI: 1306071147
Provider Name (Legal Business Name): LAURIE MARTINEZ LVN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2009
Last Update Date: 02/22/2025
Certification Date: 02/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

711 N COURT ST
VISALIA CA
93291-3638
US

IV. Provider business mailing address

711 N COURT ST
VISALIA CA
93291-3638
US

V. Phone/Fax

Practice location:
  • Phone: 559-627-1490
  • Fax: 559-622-9894
Mailing address:
  • Phone: 559-627-1490
  • Fax: 559-622-9894

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number204428
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License NumberVN 204428
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: