Provider Demographics
NPI:1629509260
Name:MARTINEZ, LESLY VICTORIA (MD, MBA, MPH)
Entity Type:Individual
Prefix:
First Name:LESLY
Middle Name:VICTORIA
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:MD, MBA, MPH
Other - Prefix:DR
Other - First Name:LESLY
Other - Middle Name:VICTORIA
Other - Last Name:MARTINEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD, MBA, MPH
Mailing Address - Street 1:201 S HARBOR BLVD
Mailing Address - Street 2:
Mailing Address - City:LA HABRA
Mailing Address - State:CA
Mailing Address - Zip Code:90631-5654
Mailing Address - Country:US
Mailing Address - Phone:562-264-6000
Mailing Address - Fax:
Practice Address - Street 1:201 S HARBOR BLVD
Practice Address - Street 2:
Practice Address - City:LA HABRA
Practice Address - State:CA
Practice Address - Zip Code:90631-5654
Practice Address - Country:US
Practice Address - Phone:562-264-6000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-24
Last Update Date:2022-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA162727207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1629509260Medicaid