Healthcare Provider Details

I. General information

NPI: 1588129191
Provider Name (Legal Business Name): BRYAN MARTINEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2019
Last Update Date: 04/02/2025
Certification Date: 04/02/2025
Deactivation Date: 04/24/2024
Reactivation Date: 07/05/2024

III. Provider practice location address

201 N COURT ST
VISALIA CA
93291-4918
US

IV. Provider business mailing address

201 N COURT ST
VISALIA CA
93291-4918
US

V. Phone/Fax

Practice location:
  • Phone: 559-627-2046
  • Fax:
Mailing address:
  • Phone: 559-627-2046
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: