Provider Demographics
NPI:1639613987
Name:MARTIN, SONIA (PHD)
Entity Type:Individual
Prefix:
First Name:SONIA
Middle Name:
Last Name:MARTIN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:293 LOS VIENTOS DR
Mailing Address - Street 2:
Mailing Address - City:NEWBURY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91320-2811
Mailing Address - Country:US
Mailing Address - Phone:805-660-3644
Mailing Address - Fax:
Practice Address - Street 1:1060 E GREEN ST
Practice Address - Street 2:SUITE 207
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91106-2408
Practice Address - Country:US
Practice Address - Phone:626-440-7001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-06
Last Update Date:2020-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY15851103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical