Basic Information
| Provider Information | |||||||||
| NPI: | 1437346921 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MARTINEZ | ||||||||
| FirstName: | HECTOR | ||||||||
| MiddleName: | GERARDO | ||||||||
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| Credential: | MSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2620 INDUSTRY WAY | ||||||||
| Address2: | SUITE C | ||||||||
| City: | LYNWOOD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 902624024 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3106674070 | ||||||||
| FaxNumber: | 3106674070 | ||||||||
| Practice Location | |||||||||
| Address1: | 2620 INDUSTRY WAY | ||||||||
| Address2: | |||||||||
| City: | LYNWOOD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 902624024 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3106674070 | ||||||||
| FaxNumber: | 3106674070 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/27/2007 | ||||||||
| LastUpdateDate: | 08/27/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/27/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | ASW63880 | CA | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 101YM0800X | ASW97927 | CA | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 104100000X | 24282 | CA | N | Behavioral Health & Social Service Providers | Social Worker | 1041C0700X | LCSW103033 | CA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.