Provider Demographics
NPI:1770022147
Name:MARTINEZ, AIMEE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:AIMEE
Middle Name:
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 N SWEETZER AVE
Mailing Address - Street 2:APT 406
Mailing Address - City:WEST HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90069-1540
Mailing Address - Country:US
Mailing Address - Phone:310-915-9414
Mailing Address - Fax:
Practice Address - Street 1:11845 W OLYMPIC BLVD
Practice Address - Street 2:SUITE 505W
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90064-1149
Practice Address - Country:US
Practice Address - Phone:310-915-9414
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-18
Last Update Date:2017-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY28937103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical