Provider Demographics
NPI:1174233936
Name:MARTINEZ, ALEXIS MARIE (PA-C)
Entity type:Individual
Prefix:
First Name:ALEXIS
Middle Name:MARIE
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3721
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92519-3721
Mailing Address - Country:US
Mailing Address - Phone:951-850-2525
Mailing Address - Fax:
Practice Address - Street 1:26600 CACTUS AVE STE 300
Practice Address - Street 2:
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92555-3901
Practice Address - Country:US
Practice Address - Phone:951-850-2525
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-01
Last Update Date:2025-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA66548363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant