Healthcare Provider Details

I. General information

NPI: 1063322188
Provider Name (Legal Business Name): JUSTIN D. MARTINEZ PPSC/ACSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2026
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

131 WESTMOOR AVE
DALY CITY CA
94015-3843
US

IV. Provider business mailing address

123 EDGEMONT DR BLDG A
DALY CITY CA
94015-3868
US

V. Phone/Fax

Practice location:
  • Phone: 650-550-7468
  • Fax:
Mailing address:
  • Phone: 650-550-7900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number121026
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: