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General NPI Number Information
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NPI Number | 1538755426
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Entity Type | Individual
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Provider Name | MAYRA MARTINEZ
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Gender | Female
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Dates
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Enumeration Date | 12/15/2020
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Last Update Date | 01/12/2022
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Provider Practice Location Address
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Address Line | 11731 TELEGRAPH RD STE E
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City | SANTA FE SPRINGS
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State | CA
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Zip | 90670-6821
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Country | US
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Telephone | 626-632-1223
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Fax |
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Provider Business Mailing Address
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Address Line | 2208 CHESTNUT AVE
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City | LONG BEACH
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State | CA
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Zip | 90806-4210
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Country | US
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Telephone |
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | ASW94208
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License Number State | CA
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