Healthcare Provider Details

I. General information

NPI: 1356003974
Provider Name (Legal Business Name): VALERIE ELIZABETH MARTINEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2021
Last Update Date: 06/09/2023
Certification Date: 06/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

365 KUCK LN
PETALUMA CA
94952-9606
US

IV. Provider business mailing address

677 POWDERHORN AVE
SANTA ROSA CA
95407-2744
US

V. Phone/Fax

Practice location:
  • Phone: 707-483-7299
  • Fax:
Mailing address:
  • Phone: 559-361-4048
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2470A2800X
TaxonomyAssistant Health Information Record Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: