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General NPI Number Information
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NPI Number | 1457098642
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Entity Type | Individual
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Provider Name | AMIE MARIE MARTINEZ SUDRC
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Gender | Female
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Dates
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Enumeration Date | 05/18/2022
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Last Update Date | 05/18/2022
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Provider Practice Location Address
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Address Line | 682 BRIERGATE WAY
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City | HAYWARD
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State | CA
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Zip | 94544-7245
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Country | US
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Telephone | 510-589-0136
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Fax |
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Provider Business Mailing Address
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Address Line | 16459 E 14TH ST APT 23
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City | SAN LEANDRO
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State | CA
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Zip | 94578-3198
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Country | US
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Telephone | 510-938-1746
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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