MEDICARE: MARTHA IRENE 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	135817	CA

General Provider Information

NPI Number	:	1699326264
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARTHA IRENE MARTINEZ

Provider Business Mailing Address
First Line	:	PO BOX 933
Second Line	:
City	:	SOUTH GATE
State	:	CA
Zip	:	90280-0933
Country	:	US
Telephone Number	:	323-331-1588
Fax Number	:

Provider Business Practice Location Address
First Line	:	8929 S SEPULVEDA BLVD STE 201
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90045-3643
Country	:	US
Telephone Number	:	310-645-5227
Fax Number	:

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

Provider Enumeration Date	:	09/25/2019
Last Update Date	:	12/02/2022

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