Healthcare Provider Details

I. General information

NPI: 1356647416
Provider Name (Legal Business Name): LETICIA N MARTINEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2011
Last Update Date: 10/21/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2351 CARDINAL LN ANNEX B
SAN DIEGO CA
92123-3743
US

IV. Provider business mailing address

2351 CARDINAL LN ANNEX B
SAN DIEGO CA
92123-3743
US

V. Phone/Fax

Practice location:
  • Phone: 858-573-2227
  • Fax:
Mailing address:
  • Phone: 858-573-2227
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225C00000X
TaxonomyRehabilitation Counselor
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number87263
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: