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General NPI Number Information
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NPI Number | 1154951630
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Entity Type | Individual
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Provider Name | JESSICA MARTINEZ OT
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Gender | Female
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Dates
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Enumeration Date | 01/23/2020
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Last Update Date | 01/23/2020
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Provider Practice Location Address
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Address Line | 15004 INNOVATION DR
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City | SAN DIEGO
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State | CA
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Zip | 92128-3491
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Country | US
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Telephone | 858-605-7189
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Fax |
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Provider Business Mailing Address
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Address Line | 10790 RANCHO BERNARDO RD # 4S-205
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City | SAN DIEGO
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State | CA
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Zip | 92127-5705
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Country | US
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Telephone | 858-927-5775
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225XN1300X
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Taxonomy Name | Neurorehabilitation Occupational Therapist
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License Number | 1895
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License Number State | CA
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