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NPI Code Detail

MEDICARE: FREDICK MARTINEZ

MEDICARE: FREDICK 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
1101Y00000XCounselor
2106S00000XBehavior Technician

General Provider Information

NPI Number : 1871971739
Entity Type Code : Individual
Provider Name (Legal Business Name) : FREDICK MARTINEZ
Provider Business Mailing Address
First Line : 50 N HILL AVE
Second Line :
City : PASADENA
State : CA
Zip : 91106-1949
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 50 N HILL AVE
Second Line :
City : PASADENA
State : CA
Zip : 91106-1949
Country : US
Telephone Number : 714-249-8095
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/12/2015
Last Update Date : 02/24/2021

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Directions to “ FREDICK MARTINEZ ” Practice Location

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