Individual
ANDREA ANAHI MARTINEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
17053 FOOTHILL BLVD, FONTANA, CA 92335-3574
(909) 347-1300
(909) 347-1302
Mailing address
PO BOX 1341, COLTON, CA 92324-0827
(714) 396-4074
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
ASW109658
CA
104100000X
Social Worker
ASW109658
CA
1041C0700X
Clinical Social Worker
Primary
LCSW132599
CA
171M00000X
Case Manager/Care Coordinator
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
20160500162100
—
CA
Enumeration date
06/15/2020
Last updated
08/06/2025
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