Basic Information
| Provider Information | |||||||||
| NPI: | 1902326655 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MARTINEZ | ||||||||
| FirstName: | ALLISON | ||||||||
| MiddleName: | JEAN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 13001 RAMONA BLVD STE I | ||||||||
| Address2: | |||||||||
| City: | IRWINDALE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917063752 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6263373828 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 13001 RAMONA BLVD STE I | ||||||||
| Address2: | |||||||||
| City: | IRWINDALE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 91706 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6263373828 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/23/2017 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 01/05/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 83011 | CA | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 1041C0700X | LCSW100742 | CA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.