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General NPI Number Information
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NPI Number | 1750782520
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Entity Type | Individual
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Provider Name | DAVID HEREDIA MARTINEZ
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Gender | Male
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Dates
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Enumeration Date | 09/10/2014
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Last Update Date | 02/18/2022
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Provider Practice Location Address
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Address Line | 149 PASADENA AVE STE A
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City | SOUTH PASADENA
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State | CA
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Zip | 91030-3351
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Country | US
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Telephone | 323-274-3065
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Fax |
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Provider Business Mailing Address
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Address Line | 940 AVENUE 64
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City | PASADENA
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State | CA
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Zip | 91105-2711
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Country | US
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Telephone | 323-254-2274
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Fax | 323-978-1263
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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 | LMFT130242
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License Number State | CA
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