Healthcare Provider Details

I. General information

NPI: 1780962886
Provider Name (Legal Business Name): MICHAEL MARTINEZ MFT TRAINEE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/25/2011
Last Update Date: 07/25/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12440 FIRESTONE BLVD
NORWALK CA
90650-4328
US

IV. Provider business mailing address

4437 WOODMAR DR
WHITTIER CA
90601-1960
US

V. Phone/Fax

Practice location:
  • Phone: 562-864-3722
  • Fax:
Mailing address:
  • Phone: 562-233-7751
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: