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General NPI Number Information
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NPI Number | 1780504613
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Entity Type | Individual
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Provider Name | TABETHA MARTIN RN
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Gender | Female
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Dates
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Enumeration Date | 07/20/2026
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Last Update Date | 07/20/2026
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Provider Practice Location Address
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Address Line | 12618 SIERRA ROJO RD
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City | VALLEY CENTER
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State | CA
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Zip | 92082-5719
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Country | US
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Telephone | 760-317-6111
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1922
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City | VALLEY CENTER
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State | CA
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Zip | 92082-1922
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Country | US
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Telephone | 760-317-6111
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 95208086
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 163WC0400X
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Taxonomy Name | Case Management Registered Nurse
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License Number | 95208086
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 163WC1500X
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Taxonomy Name | Community Health Registered Nurse
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License Number | 558692
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License Number State | CA
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Taxonomy #4
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Taxonomy Code | 163WH0200X
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Taxonomy Name | Home Health Registered Nurse
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License Number | 95208086
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License Number State | CA
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