Provider Demographics
NPI:1407430564
Name:MARTELL BARAHONA, LYZA (CASE MANAGER)
Entity Type:Individual
Prefix:
First Name:LYZA
Middle Name:
Last Name:MARTELL BARAHONA
Suffix:
Gender:F
Credentials:CASE MANAGER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 W. PALMDALE BLVD.
Mailing Address - Street 2:SUIT D
Mailing Address - City:PALMDALE
Mailing Address - State:CA
Mailing Address - Zip Code:93551
Mailing Address - Country:US
Mailing Address - Phone:661-575-8395
Mailing Address - Fax:
Practice Address - Street 1:520 W. PALMDALE BLV.
Practice Address - Street 2:
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93551
Practice Address - Country:US
Practice Address - Phone:661-575-8395
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-05
Last Update Date:2021-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator