Provider Demographics
NPI:1619249414
Name:MARTINEZ, KRISTIN MARGARET (LMFT #90136)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:MARGARET
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:LMFT #90136
Other - Prefix:
Other - First Name:KRISTIN
Other - Middle Name:MARGARET
Other - Last Name:KAISER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:13006 PHILADELPHIA ST
Mailing Address - Street 2:SUITE 210
Mailing Address - City:WHITTIER
Mailing Address - State:CA
Mailing Address - Zip Code:90601-4210
Mailing Address - Country:US
Mailing Address - Phone:562-273-2124
Mailing Address - Fax:
Practice Address - Street 1:5628 E SLAUSON AVE
Practice Address - Street 2:
Practice Address - City:COMMERCE
Practice Address - State:CA
Practice Address - Zip Code:90040-2922
Practice Address - Country:US
Practice Address - Phone:562-273-2124
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-08
Last Update Date:2017-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT #90136106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1619249414Medicaid
CA#95-2633765OtherMEDI-CAL