Provider Demographics
NPI:1568233427
Name:MARTINEZ DUENAS, AUDRIE LORRAINE
Entity Type:Individual
Prefix:
First Name:AUDRIE
Middle Name:LORRAINE
Last Name:MARTINEZ DUENAS
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 1:2708 FOOTHILL BLVD # 123
Mailing Address - Street 2:
Mailing Address - City:LA CRESCENTA
Mailing Address - State:CA
Mailing Address - Zip Code:91214-3516
Mailing Address - Country:US
Mailing Address - Phone:818-826-0606
Mailing Address - Fax:
Practice Address - Street 1:2708 FOOTHILL BLVD # 123
Practice Address - Street 2:
Practice Address - City:LA CRESCENTA
Practice Address - State:CA
Practice Address - Zip Code:91214-3516
Practice Address - Country:US
Practice Address - Phone:818-826-0606
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-10
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95027577363LA2100X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care