Healthcare Provider Details

I. General information

NPI: 1457760605
Provider Name (Legal Business Name): SAMANTHA MARTIN ZELAYA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SAMANTHA CHRISTINE MARTIN

II. Dates (important events)

Enumeration Date: 08/12/2014
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

745 E LOCUST AVE STE 106
FRESNO CA
93720
US

IV. Provider business mailing address

1111 VAN NESS AVE
FRESNO CA
93721-2002
US

V. Phone/Fax

Practice location:
  • Phone: 559-479-9224
  • Fax:
Mailing address:
  • Phone: 559-265-3000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number108599
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: