MEDICARE: MRS. LEILA LYNNE MARTINEZ

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	106H00000X	Marriage & Family Therapist	IMF59302	CA
2	101Y00000X	Counselor

General Provider Information

NPI Number	:	1386804201
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LEILA LYNNE MARTINEZ

Provider Business Mailing Address
First Line	:	4509 VISTA LARGO
Second Line	:
City	:	TORRANCE
State	:	CA
Zip	:	90505-6357
Country	:	US
Telephone Number	:	310-940-5261
Fax Number	:

Provider Business Practice Location Address
First Line	:	901 N PACIFIC COAST HWY
Second Line	:
City	:	REDONDO BEACH
State	:	CA
Zip	:	90277-2162
Country	:	US
Telephone Number	:	310-316-1610
Fax Number	:

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

Provider Enumeration Date	:	06/13/2008
Last Update Date	:	03/01/2011

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