Provider Demographics
NPI:1598216400
Name:BRIZUELA, MARTHA NAYELY
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:NAYELY
Last Name:BRIZUELA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MARTHA
Other - Middle Name:NAYELY
Other - Last Name:RODRIGUEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5600 RICKENBACKER RD # 2AB
Mailing Address - Street 2:
Mailing Address - City:BELL
Mailing Address - State:CA
Mailing Address - Zip Code:90201-6418
Mailing Address - Country:US
Mailing Address - Phone:323-263-1206
Mailing Address - Fax:
Practice Address - Street 1:5600 RICKENBACKER RD # 2AB
Practice Address - Street 2:
Practice Address - City:BELL
Practice Address - State:CA
Practice Address - Zip Code:90201-6418
Practice Address - Country:US
Practice Address - Phone:323-263-1206
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-17
Last Update Date:2023-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAB00002201021101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)