Provider Demographics
NPI:1851057780
Name:MARTINEZ, JOHNNISCHA MARIE (LVN)
Entity Type:Individual
Prefix:
First Name:JOHNNISCHA
Middle Name:MARIE
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:JOHNNISCHA
Other - Middle Name:MARIE
Other - Last Name:ROBERTS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:13333 PALMDALE RD
Mailing Address - Street 2:
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92392-9364
Mailing Address - Country:US
Mailing Address - Phone:760-487-3600
Mailing Address - Fax:
Practice Address - Street 1:13333 PALMDALE RD
Practice Address - Street 2:
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92392-9364
Practice Address - Country:US
Practice Address - Phone:760-487-3600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-15
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA231716164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse