Healthcare Provider Details

I. General information

NPI: 1700294774
Provider Name (Legal Business Name): VANESSA MARIA MARTINEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2014
Last Update Date: 06/13/2022
Certification Date: 06/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1911 WILLIAMS DR SUITE 150
OXNARD CA
93036-2612
US

IV. Provider business mailing address

1040 E COLONIA RD
OXNARD CA
93030-3710
US

V. Phone/Fax

Practice location:
  • Phone: 805-981-8460
  • Fax: 805-981-8461
Mailing address:
  • Phone: 805-248-6120
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number93254
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: