Healthcare Provider Details

I. General information

NPI: 1790693257
Provider Name (Legal Business Name): BETTY MARTINEZ CNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2026
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10619 NE 90TH ST
VANCOUVER WA
98662-2194
US

IV. Provider business mailing address

10619 NE 90TH ST
VANCOUVER WA
98662-2194
US

V. Phone/Fax

Practice location:
  • Phone: 206-383-0091
  • Fax: 360-375-7800
Mailing address:
  • Phone: 206-383-0091
  • Fax: 360-375-7800

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number758969
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: