Provider Demographics
NPI:1942689989
Name:MARTINEZ, SAM LOPEZ
Entity Type:Individual
Prefix:
First Name:SAM
Middle Name:LOPEZ
Last Name:MARTINEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:SAM
Other - Middle Name:LOPEZ
Other - Last Name:MARTINEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:11341 KNOTT AVE
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:CA
Mailing Address - Zip Code:90630-5402
Mailing Address - Country:US
Mailing Address - Phone:714-742-8983
Mailing Address - Fax:
Practice Address - Street 1:11341 KNOTT AVE
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:CA
Practice Address - Zip Code:90630-5402
Practice Address - Country:US
Practice Address - Phone:714-742-8983
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-22
Last Update Date:2015-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist