Individual
ELENA DEE MARTINEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1134 IRIS AVE, IMPERIAL BEACH, CA 91932-3527
(619) 708-6354
Mailing address
544 FLORENCE ST, IMPERIAL BEACH, CA 91932-1713
(858) 316-8330
Taxonomy
Speciality
Code
Description
License number
State
3747A0650X
Attendant Care Provider
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
C5961624
DRIVER LICENSE
CA
Enumeration date
06/21/2023
Last updated
06/21/2023
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