Basic Information
| Provider Information | |||||||||
| NPI: | 1770251399 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MARTEL | ||||||||
| FirstName: | DENNIS | ||||||||
| MiddleName: | ROBERT | ||||||||
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| Credential: | CADC LL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2601 WOODACRE ST | ||||||||
| Address2: | |||||||||
| City: | BREA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 928214734 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7145070732 | ||||||||
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| Practice Location | |||||||||
| Address1: | 771 W ORANGETHORPE AVE | ||||||||
| Address2: | |||||||||
| City: | FULLERTON | ||||||||
| State: | CA | ||||||||
| PostalCode: | 928322806 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7148790929 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/30/2021 | ||||||||
| LastUpdateDate: | 08/30/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/30/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | A051660120 | CA | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.