Healthcare Provider Details

I. General information

NPI: 1821936170
Provider Name (Legal Business Name): LAURA MARTINEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2026
Last Update Date: 03/24/2026
Certification Date: 03/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5125 E GERDA DR
ANAHEIM CA
92807-3009
US

IV. Provider business mailing address

5125 E GERDA DR
ANAHEIM CA
92807-3009
US

V. Phone/Fax

Practice location:
  • Phone: 714-628-4122
  • Fax:
Mailing address:
  • Phone: 714-628-4122
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: