Healthcare Provider Details

I. General information

NPI: 1780596221
Provider Name (Legal Business Name): BRENDA M MARTIN CMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/21/2026
Last Update Date: 09/21/2026
Certification Date: 09/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

119C BROWNS VALLEY RD
WATSONVILLE CA
95076-0325
US

IV. Provider business mailing address

119C BROWNS VALLEY RD
WATSONVILLE CA
95076-0325
US

V. Phone/Fax

Practice location:
  • Phone: 808-269-4337
  • Fax:
Mailing address:
  • Phone: 808-269-4337
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number83962
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: