Healthcare Provider Details

I. General information

NPI: 1922158351
Provider Name (Legal Business Name): RAMON A. MARTINEZ PSY.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2007
Last Update Date: 02/08/2024
Certification Date: 04/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 CALIFORNIA DRIVE DSH-V, APP UNIT Q-2
VACAVILLE CA
95696
US

IV. Provider business mailing address

1600 CALIFORNIA DRIVE CMF-PIP
VACAVILLE CA
95696
US

V. Phone/Fax

Practice location:
  • Phone: 707-448-6841
  • Fax:
Mailing address:
  • Phone: 707-410-8679
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY26417
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: