Healthcare Provider Details

I. General information

NPI: 1962652263
Provider Name (Legal Business Name): NILAY REFIYE MARTIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2008
Last Update Date: 02/26/2026
Certification Date: 02/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1263 MISSION ST
SAN FRANCISCO CA
94103-2705
US

IV. Provider business mailing address

1263 MISSION ST
SAN FRANCISCO CA
94103-2705
US

V. Phone/Fax

Practice location:
  • Phone: 628-587-9159
  • Fax: 415-514-6466
Mailing address:
  • Phone: 628-587-9159
  • Fax: 415-514-6466

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number161924
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: