Provider Demographics
NPI:1215747779
Name:MARTINEZ, ARIANA ALEXANDRA (CO61564421)
Entity type:Individual
Prefix:
First Name:ARIANA
Middle Name:ALEXANDRA
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:CO61564421
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 120
Mailing Address - Street 2:
Mailing Address - City:ROYAL CITY
Mailing Address - State:WA
Mailing Address - Zip Code:99357-0120
Mailing Address - Country:US
Mailing Address - Phone:509-793-8775
Mailing Address - Fax:
Practice Address - Street 1:33 S 2ND AVE
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98902-3414
Practice Address - Country:US
Practice Address - Phone:509-314-8450
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-08
Last Update Date:2025-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACO61564421101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)