MEDICARE: MAYRA MARTINEZ

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
1	101YM0800X	Mental Health Counselor	ASW94208	CA

General Provider Information

NPI Number	:	1538755426
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAYRA MARTINEZ

Provider Business Mailing Address
First Line	:	2208 CHESTNUT AVE
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90806-4210
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	11731 TELEGRAPH RD STE E
Second Line	:
City	:	SANTA FE SPRINGS
State	:	CA
Zip	:	90670-6821
Country	:	US
Telephone Number	:	626-632-1223
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/15/2020
Last Update Date	:	01/12/2022

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Directions to “ MAYRA MARTINEZ ” Practice Location

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