Healthcare Provider Details

I. General information

NPI: 1346180288
Provider Name (Legal Business Name): EVELYN SUSET MARTINEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/31/2026
Last Update Date: 04/01/2026
Certification Date: 04/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 S FREMONT AVE BLDG A10
ALHAMBRA CA
91803-8800
US

IV. Provider business mailing address

16227 EUCALYPTUS AVE APT 52
BELLFLOWER CA
90706-8208
US

V. Phone/Fax

Practice location:
  • Phone: 410-910-4092
  • Fax:
Mailing address:
  • Phone: 410-910-4092
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: