Healthcare Provider Details

I. General information

NPI: 1437697877
Provider Name (Legal Business Name): ELENA R MARTINEZ CADC II
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2017
Last Update Date: 12/29/2025
Certification Date: 12/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3525 PRESLEY AVE
RIVERSIDE CA
92507-4453
US

IV. Provider business mailing address

12009 ASPEN CIR APT B
GRAND TERRACE CA
92313-5054
US

V. Phone/Fax

Practice location:
  • Phone: 951-782-2400
  • Fax:
Mailing address:
  • Phone: 909-942-1928
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License NumberA049450518
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberA049450518
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: