Provider Demographics
NPI:1669981346
Name:MARTINEZ-MATA, ALEJANDRO SANTIAGO
Entity type:Individual
Prefix:
First Name:ALEJANDRO
Middle Name:SANTIAGO
Last Name:MARTINEZ-MATA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 N LINCOLN ST
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93458-4319
Mailing Address - Country:US
Mailing Address - Phone:805-928-1707
Mailing Address - Fax:
Practice Address - Street 1:105 N LINCOLN ST
Practice Address - Street 2:
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93458-4319
Practice Address - Country:US
Practice Address - Phone:805-928-1707
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-25
Last Update Date:2022-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA130760106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist