Provider Demographics
NPI:1952859324
Name:MARTINEZ, CORINA
Entity Type:Individual
Prefix:
First Name:CORINA
Middle Name:
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4553 GLENCOE AVE STE 315
Mailing Address - Street 2:
Mailing Address - City:MARINA DEL REY
Mailing Address - State:CA
Mailing Address - Zip Code:90292-7933
Mailing Address - Country:US
Mailing Address - Phone:855-427-2778
Mailing Address - Fax:424-465-6998
Practice Address - Street 1:4553 GLENCOE AVE STE 315
Practice Address - Street 2:
Practice Address - City:MARINA DEL REY
Practice Address - State:CA
Practice Address - Zip Code:90292-7933
Practice Address - Country:US
Practice Address - Phone:855-427-2778
Practice Address - Fax:424-465-6998
Is Sole Proprietor?:No
Enumeration Date:2016-09-14
Last Update Date:2022-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1078261041C0700X
CAASW77251101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical