MEDICARE: JOHNNY MARTINEZ CDAC A060511021

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
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	A060511021	CA

General Provider Information

NPI Number	:	1295621175
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHNNY MARTINEZ CDAC A060511021

Provider Business Mailing Address
First Line	:	12622 WOODLAND LN
Second Line	:
City	:	GARDEN GROVE
State	:	CA
Zip	:	92840-5509
Country	:	US
Telephone Number	:	949-922-9906
Fax Number	:

Provider Business Practice Location Address
First Line	:	12622 WOODLAND LN
Second Line	:
City	:	GARDEN GROVE
State	:	CA
Zip	:	92840-5509
Country	:	US
Telephone Number	:	949-922-9906
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/16/2025
Last Update Date	:	06/16/2025

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