Provider Demographics
NPI:1093079584
Name:MARTINEZ, ROCIO (MSW)
Entity Type:Individual
Prefix:MS
First Name:ROCIO
Middle Name:
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 861496
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90086
Mailing Address - Country:US
Mailing Address - Phone:323-543-4225
Mailing Address - Fax:323-344-7382
Practice Address - Street 1:7003 NORTH FIGUEROA STREET
Practice Address - Street 2:OPTIMIST YOUTH HOMES & FAMILY SERVICES
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90041-1076
Practice Address - Country:US
Practice Address - Phone:323-543-4225
Practice Address - Fax:323-344-7382
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-28
Last Update Date:2015-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
CA33351104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health