Basic Information
| Provider Information | |||||||||
| NPI: | 1265837801 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MARTINEZ | ||||||||
| FirstName: | TERESA | ||||||||
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| Credential: | MSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2549 LINCOLN LN | ||||||||
| Address2: | |||||||||
| City: | PALMDALE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 935515812 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8188215635 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 23501 CINEMA DR STE 200 | ||||||||
| Address2: | |||||||||
| City: | VALENCIA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913555430 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6612884800 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/24/2014 | ||||||||
| LastUpdateDate: | 02/18/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/18/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | ASW63028 | CA | N | Behavioral Health & Social Service Providers | Social Worker | Clinical | 171M00000X | ASW63028 | CA | Y | Other Service Providers | Case Manager/Care Coordinator |
No ID Information.