Healthcare Provider Details

I. General information

NPI: 1568253458
Provider Name (Legal Business Name): JENISSE MARTINEZ-VEGA DC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2025
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

690 ARCTIC ST
BRIDGEPORT CT
06608-2008
US

IV. Provider business mailing address

690 ARCTIC ST
BRIDGEPORT CT
06608-2008
US

V. Phone/Fax

Practice location:
  • Phone: 203-339-4112
  • Fax:
Mailing address:
  • Phone: 203-339-4112
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2397
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number181390
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: