Provider Demographics
NPI:1740043330
Name:MARTIN, CHRISTINA INGRID (NP-BC)
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:INGRID
Last Name:MARTIN
Suffix:
Gender:F
Credentials:NP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1917 N EBONYWOOD ST
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92865-4513
Mailing Address - Country:US
Mailing Address - Phone:714-749-4404
Mailing Address - Fax:
Practice Address - Street 1:1917 N EBONYWOOD ST
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92865-4513
Practice Address - Country:US
Practice Address - Phone:714-749-4404
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-05
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP95028105363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health