Healthcare Provider Details

I. General information

NPI: 1508990367
Provider Name (Legal Business Name): NIEVES MARTINEZ M.S. IN COUNSELING
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/15/2007
Last Update Date: 05/19/2022
Certification Date: 05/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5740 RALSTON ST STE 100
VENTURA CA
93003-7847
US

IV. Provider business mailing address

1202 MORENA BLVD STE 300
SAN DIEGO CA
92110-3844
US

V. Phone/Fax

Practice location:
  • Phone: 805-289-3100
  • 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: