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General NPI Number Information
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NPI Number | 1629418504
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Entity Type | Individual
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Provider Name | ELISA MARTINEZ LMFT
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Gender | Female
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Dates
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Enumeration Date | 06/25/2013
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Last Update Date | 09/01/2021
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Provider Practice Location Address
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Address Line | 6233 SOQUEL DR STE C
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City | APTOS
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State | CA
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Zip | 95003-3184
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Country | US
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Telephone | 831-206-3565
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 287
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City | AROMAS
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State | CA
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Zip | 95004-0287
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Country | US
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Telephone | 831-387-7657
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 98689
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License Number State | CA
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