Healthcare Provider Details

I. General information

NPI: 1306366075
Provider Name (Legal Business Name): IRVING MARTINEZ LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2017
Last Update Date: 06/25/2021
Certification Date: 06/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 W VICTORIA ST
COMPTON CA
90220-5807
US

IV. Provider business mailing address

2310 NAOMI AVE
LOS ANGELES CA
90011-1710
US

V. Phone/Fax

Practice location:
  • Phone: 310-669-9510
  • Fax: 310-669-9501
Mailing address:
  • Phone: 323-790-9114
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number77352
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number100741
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: