Individual
ANTONIA MARTINEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
233 BASELINE RD, LA VERNE, CA 91750-2353
(909) 593-2581
Mailing address
233 WEST BASELINE ROAD, LA VERNE, CA 91750
(909) 593-2581
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
7565A
OUTPATIENT MENTAL HEALTH
CA
Enumeration date
07/18/2007
Last updated
05/02/2018
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