# RENEGADE LOVE MARRIAGE AND INTIMACY THERAPY PROFESSIONAL CORPORATION

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Renegade Love Therapy
- **Organization subpart:** No

## Provider details

- **NPI number:** 1285468611
- **Authorized official:** DR. ALEXUS MARTINEZ PHD, LMFT, CST (CEO)
- **Authorized official phone:** (714) 454-3072

## Contact information

- **Practice address:** 13340 W WASHINGTON BLVD, LOS ANGELES, CA 90066-5108
- **Practice address phone:** (714) 454-3072
- **Mailing address:** 13340 W WASHINGTON BLVD, LOS ANGELES, CA 90066-5108
- **Mailing address phone:** (714) 454-3072

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 106H00000X | Marriage & Family Therapist | — | NULL | Yes |
| 106H00000X | Marriage & Family Therapist | — | — | Yes |

## Other

- **Enumeration date:** 08/28/2024
- **Last updated:** 08/28/2024