Provider Demographics
NPI:1568966158
Name:MARTINEZ, CINDY (BCBA)
Entity Type:Individual
Prefix:
First Name:CINDY
Middle Name:
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24046 CLINTON KEITH RD STE 101-163
Mailing Address - Street 2:
Mailing Address - City:WILDOMAR
Mailing Address - State:CA
Mailing Address - Zip Code:92595-8050
Mailing Address - Country:US
Mailing Address - Phone:323-420-8460
Mailing Address - Fax:
Practice Address - Street 1:24046 CLINTON KEITH RD STE 101-163
Practice Address - Street 2:
Practice Address - City:WILDOMAR
Practice Address - State:CA
Practice Address - Zip Code:92595-8050
Practice Address - Country:US
Practice Address - Phone:323-420-8460
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-20
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-24-70604103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst