Provider Demographics
NPI:1285852038
Name:MARTINEZ-VILLEGAS, ADRIENNE (CSW)
Entity Type:Individual
Prefix:MISS
First Name:ADRIENNE
Middle Name:
Last Name:MARTINEZ-VILLEGAS
Suffix:
Gender:F
Credentials:CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2036 CHESTNUT AVE
Mailing Address - Street 2:A
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90806-4604
Mailing Address - Country:US
Mailing Address - Phone:310-768-8018
Mailing Address - Fax:
Practice Address - Street 1:13931 VAN NESS AVE
Practice Address - Street 2:
Practice Address - City:GARDENA
Practice Address - State:CA
Practice Address - Zip Code:90249-2941
Practice Address - Country:US
Practice Address - Phone:310-768-8018
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA910293551041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPH-31499Medicare UPIN