Healthcare Provider Details

I. General information

NPI: 1649756529
Provider Name (Legal Business Name): AMANDA CAROL MARTINEZ BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2018
Last Update Date: 05/13/2025
Certification Date: 05/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6316 MARIPOSA AVE APT 20
CITRUS HEIGHTS CA
95610-6657
US

IV. Provider business mailing address

6316 MARIPOSA AVE APT 20
CITRUS HEIGHTS CA
95610-6657
US

V. Phone/Fax

Practice location:
  • Phone: 916-947-0454
  • Fax:
Mailing address:
  • Phone: 916-947-0454
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-25-80534
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: