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General NPI Number Information
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NPI Number | 1821648817
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Entity Type | Individual
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Provider Name | ALICIA MARTINEZ PMHNP-BC
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Gender | Female
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Dates
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Enumeration Date | 09/12/2019
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Last Update Date | 03/15/2025
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Provider Practice Location Address
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Address Line | 32000 NORTHWESTERN HWY STE 165
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City | FARMINGTON HILLS
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State | MI
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Zip | 48334-1568
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Country | US
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Telephone | 248-289-8874
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Fax | 351-207-4647
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Provider Business Mailing Address
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Address Line | 32000 NORTHWESTERN HWY STE 165
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City | FARMINGTON HILLS
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State | MI
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Zip | 48334-1568
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Country | US
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Telephone | 248-289-8874
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Fax | 351-207-4647
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | RN.429993
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 163WP0808X
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Taxonomy Name | Psychiatric/Mental Health Registered Nurse
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License Number | 4704352772
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License Number State | MI
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Taxonomy #3
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 0036525
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License Number State | OH
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Taxonomy #4
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 4704352774
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License Number State | MI
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