Provider Demographics
NPI:1700405867
Name:MARTINEZ, JAYLA
Entity Type:Individual
Prefix:
First Name:JAYLA
Middle Name:
Last Name:MARTINEZ
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 1:2764 RAMBLING VISTA RD
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91915
Mailing Address - Country:US
Mailing Address - Phone:619-746-5864
Mailing Address - Fax:
Practice Address - Street 1:5400 KEARNY MESA RD
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92111-1303
Practice Address - Country:US
Practice Address - Phone:619-717-2363
Practice Address - Fax:619-866-4213
Is Sole Proprietor?:No
Enumeration Date:2020-04-09
Last Update Date:2022-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator