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NPI Code Detail

MEDICARE: KIMBERLY MARTIN PSY.D.

MEDICARE: KIMBERLY MARTIN PSY.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103TA0400XAddiction (Substance Use Disorder) PsychologistPSY34834CA
2103TC0700XClinical PsychologistPSY34834CA
3101YA0400XAddiction (Substance Use Disorder) Counselor176124VCA

General Provider Information

NPI Number : 1134982770
Entity Type Code : Individual
Provider Name (Legal Business Name) : KIMBERLY MARTIN PSY.D.
Provider Business Mailing Address
First Line : 210 E PLEASANT VALLEY RD
Second Line :
City : PORT HUENEME
State : CA
Zip : 93041-2745
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1317 DEL NORTE RD STE 200
Second Line :
City : CAMARILLO
State : CA
Zip : 93010-8368
Country : US
Telephone Number : 805-813-1659
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/06/2024
Last Update Date : 02/06/2024

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