Healthcare Provider Details

I. General information

NPI: 1386804201
Provider Name (Legal Business Name): MRS. LEILA LYNNE MARTINEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2008
Last Update Date: 03/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 N PACIFIC COAST HWY
REDONDO BEACH CA
90277-2162
US

IV. Provider business mailing address

4509 VISTA LARGO
TORRANCE CA
90505-6357
US

V. Phone/Fax

Practice location:
  • Phone: 310-316-1610
  • Fax:
Mailing address:
  • Phone: 310-940-5261
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberIMF59302
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: