Provider Demographics
NPI:1730123282
Name:MARTIN, FELICIA DOTTORE (MFT)
Entity Type:Individual
Prefix:MRS
First Name:FELICIA
Middle Name:DOTTORE
Last Name:MARTIN
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43972 TRIOLO WAY
Mailing Address - Street 2:
Mailing Address - City:INDIO
Mailing Address - State:CA
Mailing Address - Zip Code:92203-8307
Mailing Address - Country:US
Mailing Address - Phone:760-450-7859
Mailing Address - Fax:
Practice Address - Street 1:3609 OCEAN RANCH BLVD STE 208
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92056-2700
Practice Address - Country:US
Practice Address - Phone:760-450-7859
Practice Address - Fax:760-631-8447
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-15
Last Update Date:2023-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT35573106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist