Healthcare Provider Details

I. General information

NPI: 1053954875
Provider Name (Legal Business Name): MARTHA LLAMAS LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2019
Last Update Date: 10/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2201 S AVENUE A STE 102
YUMA AZ
85364-8460
US

IV. Provider business mailing address

2201 S AVENUE A STE 102
YUMA AZ
85364-8460
US

V. Phone/Fax

Practice location:
  • Phone: 928-276-9535
  • Fax: 928-318-2044
Mailing address:
  • Phone: 928-276-9535
  • Fax: 928-318-2044

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberLMSW-6929T
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: