Healthcare Provider Details

I. General information

NPI: 1487461166
Provider Name (Legal Business Name): ABIGAIL ADRIENNE MARTINEZ M.A./AMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/16/2024
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1382 BLUE OAKS BLVD STE 213
ROSEVILLE CA
95678-7052
US

IV. Provider business mailing address

11825 CREIGHTON ST
RIVERSIDE CA
92505-3130
US

V. Phone/Fax

Practice location:
  • Phone: 877-412-8031
  • Fax:
Mailing address:
  • Phone: 951-963-6167
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number18371
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number152022
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: