Healthcare Provider Details

I. General information

NPI: 1629543285
Provider Name (Legal Business Name): KIMBERLY MARTINEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2018
Last Update Date: 04/08/2024
Certification Date: 04/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 DISTRICT CENTER DR
PALM SPRINGS CA
92264-3626
US

IV. Provider business mailing address

324 S. STATE ST. PO BOX 2784
HEMET CA
92543
US

V. Phone/Fax

Practice location:
  • Phone: 760-894-4070
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberAMFT108412
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: