MEDICARE: GABRIANNA SHAINA MARTIN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1306590732
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GABRIANNA SHAINA MARTIN

Provider Business Mailing Address
First Line	:	6400 TUPELO DR
Second Line	:
City	:	CITRUS HEIGHTS
State	:	CA
Zip	:	95621-1741
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6380 DENTON WAY APT 29
Second Line	:
City	:	CITRUS HEIGHTS
State	:	CA
Zip	:	95610-5155
Country	:	US
Telephone Number	:	424-417-9143
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/04/2022
Last Update Date	:	02/04/2022

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Directions to “ GABRIANNA SHAINA MARTIN ” Practice Location

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