Provider Demographics
NPI:1457125155
Name:MARTINEZ, GISSETTE (CHW)
Entity Type:Individual
Prefix:MS
First Name:GISSETTE
Middle Name:
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:CHW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2235 LAKESIDE PL APT 201
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92879-7957
Mailing Address - Country:US
Mailing Address - Phone:131-077-0840
Mailing Address - Fax:
Practice Address - Street 1:10801 6TH ST STE 120
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-5987
Practice Address - Country:US
Practice Address - Phone:909-767-9940
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-13
Last Update Date:2023-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker