Provider Demographics
NPI:1861611360
Name:MARTINEZ, IRESH C (BSN, RN)
Entity type:Individual
Prefix:MRS
First Name:IRESH
Middle Name:C
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:BSN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2501 COLORADO BLVD STE H
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90041-1055
Mailing Address - Country:US
Mailing Address - Phone:323-340-3962
Mailing Address - Fax:323-340-3963
Practice Address - Street 1:2501 COLORADO BLVD STE H
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90041-1055
Practice Address - Country:US
Practice Address - Phone:323-340-3962
Practice Address - Fax:323-340-3963
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA467635163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA467635OtherREGISTERED NURSE LICENSE