Healthcare Provider Details

I. General information

NPI: 1336053115
Provider Name (Legal Business Name): GLORIA E MARTINEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2026
Last Update Date: 09/30/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30920 VALIANT CT
WINCHESTER CA
92596-8056
US

IV. Provider business mailing address

30920 VALIANT CT
WINCHESTER CA
92596-8056
US

V. Phone/Fax

Practice location:
  • Phone: 951-447-9621
  • Fax:
Mailing address:
  • Phone: 951-447-9621
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number103378
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: