Healthcare Provider Details

I. General information

NPI: 1619647385
Provider Name (Legal Business Name): MARLENE MARTINEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2021
Last Update Date: 10/11/2021
Certification Date: 10/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1018 21ST ST
BAKERSFIELD CA
93301-4709
US

IV. Provider business mailing address

2116 S K ST
BAKERSFIELD CA
93304-5136
US

V. Phone/Fax

Practice location:
  • Phone: 661-861-9967
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number15098-RAC
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: