Provider Demographics
NPI:1376943001
Name:MARTINEZ, NATALIE LARIOS
Entity Type:Individual
Prefix:
First Name:NATALIE
Middle Name:LARIOS
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:NATALIE
Other - Middle Name:
Other - Last Name:LARIOS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 40039
Mailing Address - Street 2:
Mailing Address - City:DOWNEY
Mailing Address - State:CA
Mailing Address - Zip Code:90239-1039
Mailing Address - Country:US
Mailing Address - Phone:562-965-2673
Mailing Address - Fax:
Practice Address - Street 1:5201 GREAT AMERICA PKWY
Practice Address - Street 2:
Practice Address - City:SANTA CLARA
Practice Address - State:CA
Practice Address - Zip Code:95054-1122
Practice Address - Country:US
Practice Address - Phone:562-287-4706
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-29
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF93776101YM0800X, 106H00000X
CALMFT114080101YM0800X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health