Healthcare Provider Details

I. General information

NPI: 1487139143
Provider Name (Legal Business Name): IXCHEL P MARTINEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2018
Last Update Date: 12/14/2024
Certification Date: 12/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4650 W SUNSET BLVD
LOS ANGELES CA
90027-6062
US

IV. Provider business mailing address

2040 CAMFIELD AVE
COMMERCE CA
90040-1502
US

V. Phone/Fax

Practice location:
  • Phone: 323-669-2113
  • Fax: 323-201-3236
Mailing address:
  • Phone: 323-622-2429
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number85308
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number85308
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number104542
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: