Provider Demographics
NPI:1124202817
Name:MARTINEZ, DAVID ANTHONY (CCDC)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:ANTHONY
Last Name:MARTINEZ
Suffix:
Gender:M
Credentials:CCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11900 AVALON BLVD STE 200
Mailing Address - Street 2:1
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90061-2867
Mailing Address - Country:US
Mailing Address - Phone:323-242-0500
Mailing Address - Fax:323-242-0600
Practice Address - Street 1:11900 S. AVALON BLVD
Practice Address - Street 2:1
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90061
Practice Address - Country:US
Practice Address - Phone:323-242-0500
Practice Address - Fax:323-242-0600
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-18
Last Update Date:2015-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP122OtherP122