Healthcare Provider Details

I. General information

NPI: 1467991489
Provider Name (Legal Business Name): CARMALITA MARTINEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/23/2017
Last Update Date: 10/12/2023
Certification Date: 09/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2280 DIAMOND BLVD SUITE 500
CONCORD CA
94520-5750
US

IV. Provider business mailing address

1915 D ST
ANTIOCH CA
94509-2571
US

V. Phone/Fax

Practice location:
  • Phone: 925-483-2223
  • Fax: 925-826-5878
Mailing address:
  • Phone: 925-754-3673
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberR1523590923
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: