Provider Demographics
NPI:1235748609
Name:BRISENO, MARTHA C
Entity type:Individual
Prefix:
First Name:MARTHA
Middle Name:C
Last Name:BRISENO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2140 DURFEE AVE
Mailing Address - Street 2:
Mailing Address - City:EL MONTE
Mailing Address - State:CA
Mailing Address - Zip Code:91733-3715
Mailing Address - Country:US
Mailing Address - Phone:626-444-4077
Mailing Address - Fax:626-444-4003
Practice Address - Street 1:2140 DURFEE AVE
Practice Address - Street 2:
Practice Address - City:EL MONTE
Practice Address - State:CA
Practice Address - Zip Code:91733-3715
Practice Address - Country:US
Practice Address - Phone:626-444-4077
Practice Address - Fax:626-444-4003
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-30
Last Update Date:2020-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)