Provider Demographics
NPI:1437825080
Name:MARTINEZ, YAMILETH (R1375450120)
Entity Type:Individual
Prefix:
First Name:YAMILETH
Middle Name:
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:R1375450120
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3722 E 5TH ST # THS
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90063-3905
Mailing Address - Country:US
Mailing Address - Phone:323-801-5197
Mailing Address - Fax:
Practice Address - Street 1:11682 ATLANTIC AVE
Practice Address - Street 2:
Practice Address - City:LYNWOOD
Practice Address - State:CA
Practice Address - Zip Code:90262-3832
Practice Address - Country:US
Practice Address - Phone:310-537-5883
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-23
Last Update Date:2021-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAR1375450120101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)