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NPI Code Detail

MEDICARE: VANESSA MARTIN

MEDICARE: VANESSA MARTIN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103K00000XBehavior Analyst1-14-16119CA
2103K00000XBehavior AnalystBEH-000526AZ

General Provider Information

NPI Number : 1245633627
Entity Type Code : Individual
Provider Name (Legal Business Name) : VANESSA MARTIN
Provider Business Mailing Address
First Line : PO BOX 33568
Second Line :
City : SAN DIEGO
State : CA
Zip : 92163-3568
Country : US
Telephone Number : 855-223-7123
Fax Number : 619-374-7134
Provider Business Practice Location Address
First Line : 12409 W INDIAN SCHOOL RD STE B210
Second Line :
City : AVONDALE
State : AZ
Zip : 85392-9505
Country : US
Telephone Number : 855-223-7123
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/30/2014
Last Update Date : 05/28/2025

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Directions to “ VANESSA MARTIN ” Practice Location

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