Healthcare Provider Details

I. General information

NPI: 1508629007
Provider Name (Legal Business Name): PATRICIA MARTINEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/06/2024
Last Update Date: 04/17/2026
Certification Date: 04/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1225 W 6TH ST
SANTA ANA CA
92703-2101
US

IV. Provider business mailing address

1225 W 6TH ST
SANTA ANA CA
92703-2101
US

V. Phone/Fax

Practice location:
  • Phone: 714-972-1402
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberR1573860824
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: