Healthcare Provider Details

I. General information

NPI: 1588471312
Provider Name (Legal Business Name): MARTA VALLEJO GUTIERREZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/16/2024
Last Update Date: 12/16/2024
Certification Date: 12/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8616 LA TIJERA BLVD STE 408
LOS ANGELES CA
90045-3950
US

IV. Provider business mailing address

1319 AMETHYST ST APT B
REDONDO BEACH CA
90277-2420
US

V. Phone/Fax

Practice location:
  • Phone: 866-600-7598
  • Fax:
Mailing address:
  • Phone: 424-677-5696
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: