Healthcare Provider Details

I. General information

NPI: 1134049299
Provider Name (Legal Business Name): CAMILIA MARTINEZ STOLTZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2026
Last Update Date: 07/20/2026
Certification Date: 07/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 W CLARENDON AVE STE 470
PHOENIX AZ
85013-3475
US

IV. Provider business mailing address

4115 E EDGEMONT AVE
PHOENIX AZ
85008-1410
US

V. Phone/Fax

Practice location:
  • Phone: 602-354-8906
  • Fax:
Mailing address:
  • Phone: 480-208-6415
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLAC-22616
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: