Healthcare Provider Details

I. General information

NPI: 1831702646
Provider Name (Legal Business Name): ALEXANDER MARTINEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2020
Last Update Date: 01/28/2025
Certification Date: 01/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2401 E KATELLA AVE STE 440
ANAHEIM CA
92806-5982
US

IV. Provider business mailing address

76000 VERANO RD
IRVINE CA
92617-4518
US

V. Phone/Fax

Practice location:
  • Phone: 888-725-7087
  • Fax:
Mailing address:
  • Phone: 949-833-2237
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-24-77938
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: