Healthcare Provider Details

I. General information

NPI: 1679111249
Provider Name (Legal Business Name): ASHLEY ALEJANDRA MARTINEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/14/2019
Last Update Date: 01/31/2020
Certification Date: 01/31/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1170 W SHAW AVE
FRESNO CA
93711-3703
US

IV. Provider business mailing address

PO BOX 3714
PINEDALE CA
93650-3714
US

V. Phone/Fax

Practice location:
  • Phone: 559-277-3494
  • Fax:
Mailing address:
  • Phone: 559-316-1648
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225C00000X
TaxonomyRehabilitation Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number114031
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: