Provider Demographics
NPI:1346638764
Name:MARTINEZ, LUIS FERNANDO (LCSW)
Entity Type:Individual
Prefix:MR
First Name:LUIS
Middle Name:FERNANDO
Last Name:MARTINEZ
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:39155 LIBERTY ST STE G710
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94538-1525
Mailing Address - Country:US
Mailing Address - Phone:510-795-2482
Mailing Address - Fax:510-795-3972
Practice Address - Street 1:39155 LIBERTY ST STE G710
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-1525
Practice Address - Country:US
Practice Address - Phone:510-795-2434
Practice Address - Fax:510-793-3972
Is Sole Proprietor?:No
Enumeration Date:2015-01-07
Last Update Date:2022-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA895731041C0700X
CALCSW1084441041C0700X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No171M00000XOther Service ProvidersCase Manager/Care Coordinator