Healthcare Provider Details

I. General information

NPI: 1508587932
Provider Name (Legal Business Name): ALEIDA ALEXA MORENO MARTINEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2022
Last Update Date: 12/09/2024
Certification Date: 12/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 W SANTA ANA BLVD STE 100
SANTA ANA CA
92701-4134
US

IV. Provider business mailing address

3500 S GREENVILLE ST APT C14
SANTA ANA CA
92704-7009
US

V. Phone/Fax

Practice location:
  • Phone: 714-953-9373
  • Fax:
Mailing address:
  • Phone: 712-281-3759
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberR1485981022
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number143475
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: