=====================================================
General NPI Number Information
=====================================================
NPI Number | 1134049299
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CAMILIA MARTINEZ STOLTZ
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/20/2026
-----------------------------------------------------
Last Update Date | 07/20/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 300 W CLARENDON AVE STE 470
-----------------------------------------------------
City | PHOENIX
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85013-3475
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 602-354-8906
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4115 E EDGEMONT AVE
-----------------------------------------------------
City | PHOENIX
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85008-1410
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 480-208-6415
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | LAC-22616
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------