Healthcare Provider Details

I. General information

NPI: 1326900077
Provider Name (Legal Business Name): STEPHANIE MARTINEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/02/2025
Last Update Date: 12/02/2025
Certification Date: 12/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 W GARVEY AVE S STE 168
WEST COVINA CA
91790-2653
US

IV. Provider business mailing address

1900 W GARVEY AVE S STE 168
WEST COVINA CA
91790-2653
US

V. Phone/Fax

Practice location:
  • Phone: 626-778-0498
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: