Provider Demographics
NPI:1821624560
Name:MARTINEZ, BREANNA DENEE
Entity Type:Individual
Prefix:
First Name:BREANNA
Middle Name:DENEE
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 1:1901 W PACIFIC AVE STE 240
Mailing Address - Street 2:
Mailing Address - City:WEST COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91790-2090
Mailing Address - Country:US
Mailing Address - Phone:626-536-4043
Mailing Address - Fax:
Practice Address - Street 1:1901 W PACIFIC AVE STE 240
Practice Address - Street 2:
Practice Address - City:WEST COVINA
Practice Address - State:CA
Practice Address - Zip Code:91790-2090
Practice Address - Country:US
Practice Address - Phone:626-536-4043
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-13
Last Update Date:2020-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator