Provider Demographics
NPI:1295270593
Name:MARTINEZ, LUIS BENJAMIN (MS, LMFT)
Entity type:Individual
Prefix:MR
First Name:LUIS
Middle Name:BENJAMIN
Last Name:MARTINEZ
Suffix:
Gender:M
Credentials:MS, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8608 UTICA AVE STE 211
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-4879
Mailing Address - Country:US
Mailing Address - Phone:951-990-0178
Mailing Address - Fax:
Practice Address - Street 1:8608 UTICA AVE STE 211
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-4879
Practice Address - Country:US
Practice Address - Phone:951-990-0178
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-22
Last Update Date:2021-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF95768106H00000X
CALMFT115575106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist