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General NPI Number Information
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NPI Number | 1639613987
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Entity Type | Individual
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Provider Name | SONIA MARTIN PH.D.
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Gender | Female
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Dates
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Enumeration Date | 12/06/2016
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Last Update Date | 04/08/2020
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Provider Practice Location Address
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Address Line | 1060 E GREEN ST SUITE 207
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City | PASADENA
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State | CA
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Zip | 91106-2408
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Country | US
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Telephone | 626-440-7001
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Fax |
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Provider Business Mailing Address
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Address Line | 293 LOS VIENTOS DR
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City | NEWBURY PARK
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State | CA
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Zip | 91320-2811
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Country | US
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Telephone | 805-660-3644
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSY15851
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License Number State | CA
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