Healthcare Provider Details

I. General information

NPI: 1265837801
Provider Name (Legal Business Name): TERESA MARTINEZ MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2014
Last Update Date: 02/18/2021
Certification Date: 02/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23501 CINEMA DR STE 200
VALENCIA CA
91355-5430
US

IV. Provider business mailing address

2549 LINCOLN LN
PALMDALE CA
93551-5812
US

V. Phone/Fax

Practice location:
  • Phone: 661-288-4800
  • Fax:
Mailing address:
  • Phone: 818-821-5635
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberASW63028
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License NumberASW63028
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: