Basic Information
Provider Information
NPI: 1093436313
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MARTINEZ
FirstName: BRITTANEY
MiddleName: MARIE
NamePrefix:  
NameSuffix:  
Credential: LVN
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 26460 SUMMIT CIR
Address2:  
City: SANTA CLARITA
State: CA
PostalCode: 913502991
CountryCode: US
TelephoneNumber: 6612546630
FaxNumber:  
Practice Location
Address1: 26460 SUMMIT CIR
Address2:  
City: SANTA CLARITA
State: CA
PostalCode: 913502991
CountryCode: US
TelephoneNumber: 6612546630
FaxNumber:  
Other Information
ProviderEnumerationDate: 09/06/2022
LastUpdateDate: 09/06/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 09/06/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
164X00000X727395CAY Nursing Service ProvidersLicensed Vocational Nurse 

No ID Information.


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