Provider Demographics
NPI:1609444744
Name:MARTINEZ, XIOMARA REYES (AA)
Entity Type:Individual
Prefix:
First Name:XIOMARA
Middle Name:REYES
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:AA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2011 WEATHERVANE AVE
Mailing Address - Street 2:
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92027-3735
Mailing Address - Country:US
Mailing Address - Phone:760-802-9486
Mailing Address - Fax:
Practice Address - Street 1:2125 CITRACADO PKWY STE 200
Practice Address - Street 2:
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92029-4159
Practice Address - Country:US
Practice Address - Phone:760-294-9270
Practice Address - Fax:760-294-9268
Is Sole Proprietor?:No
Enumeration Date:2021-06-15
Last Update Date:2021-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator