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General NPI Number Information
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NPI Number | 1356926273
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Entity Type | Individual
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Provider Name | JONATHAN DE JESUS MARTINEZ
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Gender | Male
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Dates
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Enumeration Date | 03/11/2021
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Last Update Date | 11/27/2024
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Provider Practice Location Address
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Address Line | 740 W 190TH ST STE A
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City | GARDENA
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State | CA
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Zip | 90248-4235
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Country | US
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Telephone | 562-306-2925
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 933
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City | SOUTH GATE
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State | CA
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Zip | 90280-0933
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Country | US
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Telephone | 323-671-0633
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 148016
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License Number State | CA
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