Healthcare Provider Details

I. General information

NPI: 1043955453
Provider Name (Legal Business Name): ERNEST MARTINEZ CHEVEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: ERNESTO MARTINEZ

II. Dates (important events)

Enumeration Date: 04/29/2022
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1118 N MCCADDEN PL
LOS ANGELES CA
90038-1213
US

IV. Provider business mailing address

1238 S TREMAINE AVE
LOS ANGELES CA
90019-1722
US

V. Phone/Fax

Practice location:
  • Phone: 323-933-7400
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number143628
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: