Provider Demographics
NPI:1134268485
Name:LOAIZA, MARTIN A (LISAC)
Entity type:Individual
Prefix:MR
First Name:MARTIN
Middle Name:A
Last Name:LOAIZA
Suffix:
Gender:M
Credentials:LISAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3559 E CUADRILLA LN
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85365-4601
Mailing Address - Country:US
Mailing Address - Phone:928-341-4140
Mailing Address - Fax:
Practice Address - Street 1:3250 E 40TH ST STE A
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85365-7994
Practice Address - Country:US
Practice Address - Phone:928-341-4140
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2014-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLISAC - 1248101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)