Provider Demographics
NPI:1033955307
Name:MARTINEZ, ABCEDE REANNA (RN)
Entity type:Individual
Prefix:
First Name:ABCEDE
Middle Name:REANNA
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5500 OVERLAND AVE STE 370
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-1202
Mailing Address - Country:US
Mailing Address - Phone:619-236-2191
Mailing Address - Fax:
Practice Address - Street 1:5500 OVERLAND AVE STE 370
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-1202
Practice Address - Country:US
Practice Address - Phone:619-236-2191
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-05
Last Update Date:2024-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95321323163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse