Provider Demographics
NPI:1316281496
Name:LEMUS, MARTIN (BCABA)
Entity type:Individual
Prefix:
First Name:MARTIN
Middle Name:
Last Name:LEMUS
Suffix:
Gender:M
Credentials:BCABA
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 122279
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91912-6979
Mailing Address - Country:US
Mailing Address - Phone:619-691-1880
Mailing Address - Fax:
Practice Address - Street 1:300 S IMPERIAL AVE STE 6
Practice Address - Street 2:
Practice Address - City:EL CENTRO
Practice Address - State:CA
Practice Address - Zip Code:92243-3149
Practice Address - Country:US
Practice Address - Phone:760-353-8500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-15
Last Update Date:2012-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA0125172103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst