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General NPI Number Information
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NPI Number | 1235875527
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Entity Type | Individual
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Provider Name | BRANDY MARTINEZ PA-C, CAQ-PSYCH
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Gender | Female
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Dates
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Enumeration Date | 05/09/2022
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Last Update Date | 09/30/2025
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Provider Practice Location Address
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Address Line | 3151 AIRWAY AVE STE G1
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City | COSTA MESA
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State | CA
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Zip | 92626-4624
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Country | US
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Telephone | 714-545-5550
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Fax | 714-708-2588
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Provider Business Mailing Address
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Address Line | 19782 MACARTHUR BLVD STE 300
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City | IRVINE
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State | CA
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Zip | 92612-2417
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Country | US
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Telephone | 714-545-5550
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Fax | 949-991-2040
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA62086
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 364SP0808X
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Taxonomy Name | Psychiatric/Mental Health Clinical Nurse Specialist
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License Number | PA62086
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License Number State | CA
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