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General NPI Number Information
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NPI Number | 1679604961
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Entity Type | Individual
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Provider Name | ROBERT RICHARD MARTINEZ JR. MFTI
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Gender | Male
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Dates
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Enumeration Date | 03/08/2007
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Last Update Date | 07/31/2009
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Provider Practice Location Address
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Address Line | 3200 MOTOR AVE
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City | LOS ANGELES
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State | CA
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Zip | 90034-3710
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Country | US
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Telephone | 323-404-2761
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Fax |
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Provider Business Mailing Address
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Address Line | 468 N MARENGO AVE
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City | PASADENA
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State | CA
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Zip | 91101-1308
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Country | US
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Telephone | 323-404-2761
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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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