Individual
TIFFANY ROSE NICOLE MARTINEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPT
Contact information
Practice address
3707 E SHIELDS AVE, FRESNO, CA 93726-7029
(559) 229-9040
(559) 229-9060
Mailing address
3707 E SHIELDS AVE, FRESNO, CA 93726-7029
(559) 229-9040
(559) 229-9060
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
PT 34123
CA
167G00000X
Licensed Psychiatric Technician
Primary
34123
CA
Other
Enumeration date
11/05/2008
Last updated
01/11/2021
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