Healthcare Provider Details

I. General information

NPI: 1316409691
Provider Name (Legal Business Name): EMILY MARTINEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/04/2019
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9903 SANTA MONICA BLVD STE 823
BEVERLY HILLS CA
90212-1606
US

IV. Provider business mailing address

9903 SANTA MONICA BLVD STE 823
BEVERLY HILLS CA
90212-1671
US

V. Phone/Fax

Practice location:
  • Phone: 310-299-2040
  • Fax:
Mailing address:
  • Phone: 310-299-2040
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLMFT160112
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: