Provider Demographics
NPI:1164948519
Name:MARTINEZ, STEPHANIE ELIZABETH
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:ELIZABETH
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18943 DAMASCO ST
Mailing Address - Street 2:
Mailing Address - City:WEST COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91792-3038
Mailing Address - Country:US
Mailing Address - Phone:626-643-6557
Mailing Address - Fax:
Practice Address - Street 1:1520 N RAYMOND AVE
Practice Address - Street 2:BLDG 2-7
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91103-9110
Practice Address - Country:US
Practice Address - Phone:626-396-5920
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-17
Last Update Date:2021-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program