Provider Demographics
NPI:1417412669
Name:MARTINEZ, NANCY (PSYD)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44349 LOWTREE AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93534-4104
Mailing Address - Country:US
Mailing Address - Phone:661-349-7139
Mailing Address - Fax:
Practice Address - Street 1:44349 LOWTREE AVE STE 101
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93534-4104
Practice Address - Country:US
Practice Address - Phone:661-644-8389
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-01
Last Update Date:2019-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSB94023958101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health