Provider Demographics
NPI:1295545051
Name:MARTINEZ, TANIA (MS COUNSELING, PPS)
Entity type:Individual
Prefix:
First Name:TANIA
Middle Name:
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:MS COUNSELING, PPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1227 97TH AVE
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94603-2456
Mailing Address - Country:US
Mailing Address - Phone:510-927-8449
Mailing Address - Fax:
Practice Address - Street 1:38569 CANYON HEIGHTS DR
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94536-1899
Practice Address - Country:US
Practice Address - Phone:510-793-1441
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-13
Last Update Date:2025-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA200132666101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool