Healthcare Provider Details

I. General information

NPI: 1780076737
Provider Name (Legal Business Name): CIRILDA MARTINEZ M.S
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CIRILDA VALDEZ M.S.

II. Dates (important events)

Enumeration Date: 02/28/2015
Last Update Date: 03/26/2021
Certification Date: 03/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12440 FIRESTONE BLVD STE 1000
NORWALK CA
90650-4366
US

IV. Provider business mailing address

6455 ORIZABA AVE
LONG BEACH CA
90805-3358
US

V. Phone/Fax

Practice location:
  • Phone: 562-864-3722
  • Fax:
Mailing address:
  • Phone: 213-610-5811
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberIMF84639
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: