Provider Demographics
NPI:1376213116
Name:MARTINEZ, MADELEINE BEDIONES II (AMFT, APCC, BSHS)
Entity type:Individual
Prefix:MS
First Name:MADELEINE
Middle Name:BEDIONES
Last Name:MARTINEZ
Suffix:II
Gender:F
Credentials:AMFT, APCC, BSHS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1794 ELM AVE
Mailing Address - Street 2:
Mailing Address - City:LOMA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92354-1788
Mailing Address - Country:US
Mailing Address - Phone:909-831-4133
Mailing Address - Fax:
Practice Address - Street 1:2829 S CEDAR RIDGE PL
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91761-7435
Practice Address - Country:US
Practice Address - Phone:909-923-0735
Practice Address - Fax:909-218-7654
Is Sole Proprietor?:No
Enumeration Date:2021-09-14
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA132498101Y00000X
CA11571101YM0800X
172V00000X
CAAMFT132498106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No172V00000XOther Service ProvidersCommunity Health Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1629667894Medicaid