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General NPI Number Information
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NPI Number | 1134479397
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Entity Type | Individual
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Provider Name | MISS MADELYNE MILDRED MARTINEZ
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Gender | Female
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Dates
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Enumeration Date | 09/14/2012
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Last Update Date | 12/30/2022
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Provider Practice Location Address
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Address Line | 2632 E THOMAS RD STE 101
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City | PHOENIX
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State | AZ
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Zip | 85016-8220
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Country | US
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Telephone | 602-957-2507
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Fax | 602-957-2510
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Provider Business Mailing Address
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Address Line | 3200 MOTOR AVENUE
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City | LOS ANGELES
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State | CA
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Zip | 90034
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Country | US
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Telephone | 310-836-1223
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LCSW17998
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 225400000X
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Taxonomy Name | Rehabilitation Practitioner
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License Number |
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License Number State |
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