Healthcare Provider Details

I. General information

NPI: 1124931159
Provider Name (Legal Business Name): RAUL A MARTINEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2026
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1731 MENLO AVE
LOS ANGELES CA
90006-4613
US

IV. Provider business mailing address

13181 CROSSROADS PKWY N
CITY OF INDUSTRY CA
91746-3419
US

V. Phone/Fax

Practice location:
  • Phone: 323-734-3284
  • Fax:
Mailing address:
  • Phone: 323-499-3650
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberRT1449780726
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: