Healthcare Provider Details

I. General information

NPI: 1043441744
Provider Name (Legal Business Name): MISS SANDRA I MARTINEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/30/2009
Last Update Date: 10/04/2022
Certification Date: 10/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20151 NORDHOFF ST
CHATSWORTH CA
91311-6215
US

IV. Provider business mailing address

20151 NORDHOFF ST
CHATSWORTH CA
91311-6215
US

V. Phone/Fax

Practice location:
  • Phone: 818-407-3200
  • Fax:
Mailing address:
  • Phone: 818-407-3200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number29117
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number61379
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: