Provider Demographics
NPI:1982155479
Name:MARTINEZ, JULIA ANN
Entity Type:Individual
Prefix:
First Name:JULIA
Middle Name:ANN
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5362 BLINN LN
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92603-3525
Mailing Address - Country:US
Mailing Address - Phone:949-525-8965
Mailing Address - Fax:
Practice Address - Street 1:1231 E DYER RD STE 135
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-5643
Practice Address - Country:US
Practice Address - Phone:714-788-4352
Practice Address - Fax:714-796-2150
Is Sole Proprietor?:No
Enumeration Date:2016-10-19
Last Update Date:2020-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA49709106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist