Healthcare Provider Details

I. General information

NPI: 1962091330
Provider Name (Legal Business Name): JOCELYN MARTINEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/11/2021
Last Update Date: 10/01/2025
Certification Date: 10/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11731 TELEGRAPH RD
SANTA FE SPRINGS CA
90670-3675
US

IV. Provider business mailing address

7104 BONITA DR
HIGHLAND CA
92346-3225
US

V. Phone/Fax

Practice location:
  • Phone: 562-907-7429
  • Fax:
Mailing address:
  • Phone: 562-237-3771
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW134225
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberASW97448
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: