Healthcare Provider Details

I. General information

NPI: 1639613987
Provider Name (Legal Business Name): SONIA MARTIN PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/06/2016
Last Update Date: 04/08/2020
Certification Date: 04/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1060 E GREEN ST SUITE 207
PASADENA CA
91106-2408
US

IV. Provider business mailing address

293 LOS VIENTOS DR
NEWBURY PARK CA
91320-2811
US

V. Phone/Fax

Practice location:
  • Phone: 626-440-7001
  • Fax:
Mailing address:
  • Phone: 805-660-3644
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY15851
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: