Provider Demographics
NPI:1770578510
Name:MARTIN, JANA N (PHD)
Entity type:Individual
Prefix:DR
First Name:JANA
Middle Name:N
Last Name:MARTIN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2017 PALO VERDE AVE
Mailing Address - Street 2:SUITE 203
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90815-3300
Mailing Address - Country:US
Mailing Address - Phone:562-596-7719
Mailing Address - Fax:562-596-1174
Practice Address - Street 1:2017 PALO VERDE AVE
Practice Address - Street 2:SUITE 203
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90815-3300
Practice Address - Country:US
Practice Address - Phone:562-596-7719
Practice Address - Fax:562-596-1174
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY10960103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACP10960Medicare ID - Type Unspecified