Healthcare Provider Details

I. General information

NPI: 1992120778
Provider Name (Legal Business Name): SARA CRISTINA MARTIN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SARA CRISTINA LOPEZ

II. Dates (important events)

Enumeration Date: 03/03/2014
Last Update Date: 03/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1838 EASTMAN AVE STE 100
VENTURA CA
93003-6498
US

IV. Provider business mailing address

1838 EASTMAN AVENUE, SUITE 100
VENTURA CA
93003
US

V. Phone/Fax

Practice location:
  • Phone: 805-289-0120
  • Fax:
Mailing address:
  • Phone: 805-289-0120
  • 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: