Provider Demographics
NPI:1962242776
Name:BURNS, MARTHA JANE (PEER SUPPORT SPECIAL)
Entity type:Individual
Prefix:
First Name:MARTHA
Middle Name:JANE
Last Name:BURNS
Suffix:
Gender:F
Credentials:PEER SUPPORT SPECIAL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6705 DE ANZA AVE
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92506-3007
Mailing Address - Country:US
Mailing Address - Phone:951-533-7031
Mailing Address - Fax:
Practice Address - Street 1:6705 DE ANZA AVE
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92506-3007
Practice Address - Country:US
Practice Address - Phone:951-533-7031
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-29
Last Update Date:2024-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist