Provider Demographics
NPI:1124497326
Name:MARTINEZ, CATALINA ANA (PHD)
Entity type:Individual
Prefix:DR
First Name:CATALINA
Middle Name:ANA
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23905 CLINTON KEITH RD # 114-411
Mailing Address - Street 2:
Mailing Address - City:WILDOMAR
Mailing Address - State:CA
Mailing Address - Zip Code:92595-7897
Mailing Address - Country:US
Mailing Address - Phone:951-225-1347
Mailing Address - Fax:951-344-8261
Practice Address - Street 1:23905 CLINTON KEITH RD # 114-411
Practice Address - Street 2:
Practice Address - City:WILDOMAR
Practice Address - State:CA
Practice Address - Zip Code:92595-7897
Practice Address - Country:US
Practice Address - Phone:951-225-1347
Practice Address - Fax:951-344-8261
Is Sole Proprietor?:No
Enumeration Date:2015-09-17
Last Update Date:2015-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA27625103T00000X
TX34624103T00000X
TX32090103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool