Provider Demographics
NPI:1114188612
Name:SAMARTIN, CECILIA (MFT)
Entity Type:Individual
Prefix:MS
First Name:CECILIA
Middle Name:
Last Name:SAMARTIN
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 DAROCA AVE
Mailing Address - Street 2:
Mailing Address - City:SAN GABRIEL
Mailing Address - State:CA
Mailing Address - Zip Code:91775-2904
Mailing Address - Country:US
Mailing Address - Phone:626-282-1783
Mailing Address - Fax:626-282-1783
Practice Address - Street 1:420 DAROCA AVE
Practice Address - Street 2:
Practice Address - City:SAN GABRIEL
Practice Address - State:CA
Practice Address - Zip Code:91775-2904
Practice Address - Country:US
Practice Address - Phone:626-282-1783
Practice Address - Fax:626-282-1783
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-18
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC31856106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist