Provider Demographics
NPI:1740955913
Name:MARTINEZ, LAUREN KRISTA
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:KRISTA
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LAUREN
Other - Middle Name:
Other - Last Name:EDMONDS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:15161 JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:MIDWAY CITY
Mailing Address - State:CA
Mailing Address - Zip Code:92655-1432
Mailing Address - Country:US
Mailing Address - Phone:714-642-8844
Mailing Address - Fax:714-893-6858
Practice Address - Street 1:24636 TARAZONA
Practice Address - Street 2:
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92692-2353
Practice Address - Country:US
Practice Address - Phone:714-476-5976
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-10
Last Update Date:2021-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator