Provider Demographics
NPI:1851969075
Name:MARTINEZ, CHRISTINA CECILIA
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:CECILIA
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 1:11790 CARMINE ST
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92505-3323
Mailing Address - Country:US
Mailing Address - Phone:951-470-4020
Mailing Address - Fax:
Practice Address - Street 1:1950 S SUNWEST LN SUITE 200
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92415-3323
Practice Address - Country:US
Practice Address - Phone:909-252-4011
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-14
Last Update Date:2021-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program