Healthcare Provider Details

I. General information

NPI: 1093138091
Provider Name (Legal Business Name): IMELDA ALAS MARTINEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/27/2014
Last Update Date: 08/31/2022
Certification Date: 08/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14911 ORIZABA AVE
PARAMOUNT CA
90723-3534
US

IV. Provider business mailing address

921 E COMPTON BLVD
COMPTON CA
90221-3303
US

V. Phone/Fax

Practice location:
  • Phone: 562-714-7201
  • Fax:
Mailing address:
  • Phone: 310-668-6800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number97556
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: