Provider Demographics
NPI:1972033934
Name:MARTINEZ, MONICA (RBT)
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1784 E ALAMO RD
Mailing Address - Street 2:
Mailing Address - City:HOLTVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92250-1218
Mailing Address - Country:US
Mailing Address - Phone:760-222-8635
Mailing Address - Fax:
Practice Address - Street 1:1413 W STATE ST
Practice Address - Street 2:
Practice Address - City:EL CENTRO
Practice Address - State:CA
Practice Address - Zip Code:92243-2834
Practice Address - Country:US
Practice Address - Phone:760-370-9232
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-13
Last Update Date:2017-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARBT-15-06323106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician