Individual
MISTY MARIE MARTIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2085 RUSTIN AVE, RIVERSIDE, CA 92507-2498
(951) 329-6580
Mailing address
2085 RUSTIN AVE, RIVERSIDE, CA 92507-2498
(951) 782-2400
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
CA
172V00000X
Community Health Worker
—
—
175T00000X
Peer Specialist
Primary
VEYZCRILABDTNOKJ
CA
Other
Enumeration date
04/03/2020
Last updated
05/07/2024
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