Healthcare Provider Details

I. General information

NPI: 1588021141
Provider Name (Legal Business Name): KARLA R MARTINEZ MS, AMFT, APCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2016
Last Update Date: 03/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

151 KALMUS DR STE 145
COSTA MESA CA
92626-5988
US

IV. Provider business mailing address

PO BOX 6055
ANAHEIM CA
92816-0055
US

V. Phone/Fax

Practice location:
  • Phone: 714-392-9383
  • Fax:
Mailing address:
  • Phone: 949-515-5440
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: