Basic Information
| Provider Information | |||||||||
| NPI: | 1346692381 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MARTINEZ | ||||||||
| FirstName: | HILARIO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5918 EBEY AVE | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900424941 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3236170855 | ||||||||
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| Practice Location | |||||||||
| Address1: | 10929 SOUTH ST STE 208B | ||||||||
| Address2: | |||||||||
| City: | CERRITOS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 907035391 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5628656444 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/01/2016 | ||||||||
| LastUpdateDate: | 04/13/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 04/13/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
ID Information
| ID | Type | State | Issuer | Description | 99745160D | 05 | CA | MEDICAID | 99745160D-01 | 05 | CA | MEDICAID |