Provider Demographics
NPI:1285385294
Name:ESPITIA MARTINEZ, ALEXANDRA SAMARAH (RADT I)
Entity type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:SAMARAH
Last Name:ESPITIA MARTINEZ
Suffix:
Gender:F
Credentials:RADT I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1750 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92101-2754
Mailing Address - Country:US
Mailing Address - Phone:619-362-9905
Mailing Address - Fax:
Practice Address - Street 1:7592 BROADWAY
Practice Address - Street 2:
Practice Address - City:LEMON GROVE
Practice Address - State:CA
Practice Address - Zip Code:91945-1604
Practice Address - Country:US
Practice Address - Phone:619-515-2550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-11
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAR1477240822101YA0400X
175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)