Healthcare Provider Details

I. General information

NPI: 1780546614
Provider Name (Legal Business Name): KAYLY ANN MARTINEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2025
Last Update Date: 12/01/2025
Certification Date: 11/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18226 VENTURA BLVD STE 202
TARZANA CA
91356-4246
US

IV. Provider business mailing address

21200 KITTRIDGE ST APT 3215
WOODLAND HILLS CA
91303-3066
US

V. Phone/Fax

Practice location:
  • Phone: 818-975-8097
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: