Healthcare Provider Details

I. General information

NPI: 1588203731
Provider Name (Legal Business Name): MARTHA PATRICIA PEREZ-QUINTANILLA LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2020
Last Update Date: 05/22/2025
Certification Date: 05/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1650 LAS PLUMAS AVE STE K
SAN JOSE CA
95133-1657
US

IV. Provider business mailing address

1650 LAS PLUMAS AVE STE K
SAN JOSE CA
95133-1657
US

V. Phone/Fax

Practice location:
  • Phone: 408-272-6726
  • Fax:
Mailing address:
  • Phone: 408-272-6726
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number17558
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number145604
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: