Healthcare Provider Details

I. General information

NPI: 1518116458
Provider Name (Legal Business Name): DULCE M MARTINEZ MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2008
Last Update Date: 12/03/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12450 VAN NUYS BLVD SUITE 100
PACOIMA CA
91331-1391
US

IV. Provider business mailing address

18040 SHERMAN WAY
RESEDA CA
91335-4631
US

V. Phone/Fax

Practice location:
  • Phone: 818-896-8366
  • Fax: 818-896-8392
Mailing address:
  • Phone: 800-700-8705
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number29556
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: