Healthcare Provider Details

I. General information

NPI: 1821648817
Provider Name (Legal Business Name): ALICIA MARTINEZ PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2019
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3450 W CENTRAL AVE STE 122
TOLEDO OH
43606-1421
US

IV. Provider business mailing address

3450 W CENTRAL AVE STE 122
TOLEDO OH
43606-1421
US

V. Phone/Fax

Practice location:
  • Phone: 419-210-3660
  • Fax: 734-344-7431
Mailing address:
  • Phone: 419-210-3660
  • Fax: 734-344-7431

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number0036525
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN.429993
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number4704352772
License Number StateMI
# 4
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number4704352774
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: