MEDICARE: ELIZABETH 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	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1720695083
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH MARTINEZ

Provider Business Mailing Address
First Line	:	1055 E COLORADO BLVD STE 560
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91106-2380
Country	:	US
Telephone Number	:	818-241-6780
Fax Number	:	818-241-6853

Provider Business Practice Location Address
First Line	:	55 E COLORADO BLVD STE 560
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91105-1901
Country	:	US
Telephone Number	:	818-241-6780
Fax Number	:

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

Provider Enumeration Date	:	09/29/2020
Last Update Date	:	09/29/2020

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