Provider Demographics
NPI:1033757711
Name:MARTINEZ, BRANDON REY (MSN, PMHNP-BC, APRN)
Entity Type:Individual
Prefix:
First Name:BRANDON
Middle Name:REY
Last Name:MARTINEZ
Suffix:
Gender:M
Credentials:MSN, PMHNP-BC, APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6545 TIMBER POINT ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89148-4297
Mailing Address - Country:US
Mailing Address - Phone:702-526-7610
Mailing Address - Fax:
Practice Address - Street 1:3911 SORRENTO VALLEY BLVD STE 130
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92121-1457
Practice Address - Country:US
Practice Address - Phone:702-526-7610
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-13
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV825008363LP0808X
CA95022290363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV825008OtherNEVADA APRN LICENSE
CA95022290OtherCALIFORNIA NURSE PRACTITIONER AND NURSE PRACTITIONER FURNISHING/PRESCRIBING LIC.
NVCS29727OtherNEVADA BOARD OF PHARMACY
NV825008OtherNEVADA APRN LICENSE
NVXM5900584OtherDEA#
NVCS29727OtherNEVADA BOARD OF PHARMACY