Healthcare Provider Details

I. General information

NPI: 1972805729
Provider Name (Legal Business Name): MARIA DE LOS ANGELES MARTINEZ MS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/30/2010
Last Update Date: 07/30/2024
Certification Date: 07/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44199 MONROE ST STE B
INDIO CA
92201-3094
US

IV. Provider business mailing address

4095 COUNTY CIRCLE DR
RIVERSIDE CA
92503
US

V. Phone/Fax

Practice location:
  • Phone: 760-863-2571
  • Fax: 951-784-4976
Mailing address:
  • Phone: 760-863-8455
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberIMF 64885
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLMFT107316
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: