Provider Demographics
NPI:1457824666
Name:MARTINEZ, HEIDI SAMANTHA (MSN, FNP)
Entity Type:Individual
Prefix:
First Name:HEIDI
Middle Name:SAMANTHA
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:MSN, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4284 SAN BERNARDINO ST
Mailing Address - Street 2:
Mailing Address - City:MONTCLAIR
Mailing Address - State:CA
Mailing Address - Zip Code:91763-2632
Mailing Address - Country:US
Mailing Address - Phone:909-278-4869
Mailing Address - Fax:
Practice Address - Street 1:453 E ARROW HWY
Practice Address - Street 2:
Practice Address - City:AZUSA
Practice Address - State:CA
Practice Address - Zip Code:91702-5612
Practice Address - Country:US
Practice Address - Phone:626-915-1748
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-10
Last Update Date:2019-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95010657363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily