Provider Demographics
NPI:1295570919
Name:MARTINEZ, MICHELLE VIRGINIA (AMFT)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:VIRGINIA
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:AMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1621
Mailing Address - Street 2:
Mailing Address - City:CLAREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:91711-8621
Mailing Address - Country:US
Mailing Address - Phone:760-490-2832
Mailing Address - Fax:
Practice Address - Street 1:3491 CONCOURS STE 203
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91764-5927
Practice Address - Country:US
Practice Address - Phone:909-284-4504
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-25
Last Update Date:2024-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist