Individual
BRIANDA BLANCA MARTINEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
124 COCOANUT ST, BRENTWOOD, NY 11717-7204
(631) 398-1921
Mailing address
124 COCOANUT ST, BRENTWOOD, NY 11717-7204
(631) 398-1921
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
340245
NY
Other
Enumeration date
12/06/2020
Last updated
12/06/2020
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