Healthcare Provider Details

I. General information

NPI: 1124785399
Provider Name (Legal Business Name): JEANA MARTINEZ M.S., LMFT 129165
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/23/2021
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2228 LAVENDER CT
SAN JACINTO CA
92582-3717
US

IV. Provider business mailing address

1157 LAS ROSAS DR
SAN JACINTO CA
92583-4844
US

V. Phone/Fax

Practice location:
  • Phone: 951-313-2270
  • Fax:
Mailing address:
  • Phone: 951-313-2270
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number129165
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: