Provider Demographics
NPI:1043967938
Name:MARTINEZ, GISELLE ADALY
Entity Type:Individual
Prefix:
First Name:GISELLE
Middle Name:ADALY
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4245 BONITA DR
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92056-4736
Mailing Address - Country:US
Mailing Address - Phone:760-529-7266
Mailing Address - Fax:
Practice Address - Street 1:3813 PLAZA DR
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92056-4624
Practice Address - Country:US
Practice Address - Phone:760-941-0712
Practice Address - Fax:760-941-5334
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-09
Last Update Date:2022-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CATCH166995183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician