Provider Demographics
NPI:1598815953
Name:MARTINEZ, EUFEL RAMOS
Entity Type:Individual
Prefix:
First Name:EUFEL
Middle Name:RAMOS
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:EUFEL
Other - Middle Name:MACARAIG
Other - Last Name:RAMOS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1499 HUNTINGTON DR STE 101
Mailing Address - Street 2:
Mailing Address - City:SOUTH PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91030-5444
Mailing Address - Country:US
Mailing Address - Phone:626-403-4370
Mailing Address - Fax:
Practice Address - Street 1:1499 HUNTINGTON DR STE 101
Practice Address - Street 2:
Practice Address - City:SOUTH PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91030-5444
Practice Address - Country:US
Practice Address - Phone:626-403-4370
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2022-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X, 174400000X
CALCSW722871041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1265620183Medicaid
CA1306922554Medicaid
CA1841342318Medicaid