Healthcare Provider Details

I. General information

NPI: 1407044720
Provider Name (Legal Business Name): VICTORIA MARTINEZ M.S
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/11/2007
Last Update Date: 09/23/2022
Certification Date: 09/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

209 E 7TH ST
MADERA CA
93638-3780
US

IV. Provider business mailing address

209 E 7TH ST
MADERA CA
93638-3780
US

V. Phone/Fax

Practice location:
  • Phone: 559-673-3508
  • Fax: 559-661-2818
Mailing address:
  • Phone: 559-673-3508
  • Fax: 559-661-2818

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number134765
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: