Healthcare Provider Details

I. General information

NPI: 1285172403
Provider Name (Legal Business Name): SARA MARTINEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: REMY MARTINEZ

II. Dates (important events)

Enumeration Date: 02/08/2017
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 MOTOR AVE
LOS ANGELES CA
90034-3740
US

IV. Provider business mailing address

3200 MOTOR AVE
LOS ANGELES CA
90034-3740
US

V. Phone/Fax

Practice location:
  • Phone: 310-836-1223
  • Fax: 310-842-9529
Mailing address:
  • Phone: 310-836-1223
  • Fax: 310-842-9529

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number22152
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number162143
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: