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NPI Code Detail

MEDICARE: MS. AVA CHRISTINE MARTINEZ LMFT

MEDICARE:  MS. AVA CHRISTINE MARTINEZ  LMFT
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
1101Y00000XCounselor110447CA
2106H00000XMarriage & Family Therapist110447CA
3106H00000XMarriage & Family Therapist126449CA

General Provider Information

NPI Number : 1700445962
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. AVA CHRISTINE MARTINEZ LMFT
Provider Business Mailing Address
First Line : 11645 MONTANA AVE APT 224
Second Line :
City : LOS ANGELES
State : CA
Zip : 90049-4644
Country : US
Telephone Number : 415-377-0354
Fax Number :
Provider Business Practice Location Address
First Line : 11645 MONTANA AVE APT 224
Second Line :
City : LOS ANGELES
State : CA
Zip : 90049-4644
Country : US
Telephone Number : 315-377-0354
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/11/2019
Last Update Date : 07/11/2021

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