Provider Demographics
NPI:1346427655
Name:MARTINEZ, ROSA
Entity type:Individual
Prefix:
First Name:ROSA
Middle Name:
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:816 BAKER ST
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93305-5213
Mailing Address - Country:US
Mailing Address - Phone:661-327-9376
Mailing Address - Fax:661-327-7649
Practice Address - Street 1:2001 28TH ST
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93301-1924
Practice Address - Country:US
Practice Address - Phone:661-868-8757
Practice Address - Fax:661-861-1033
Is Sole Proprietor?:No
Enumeration Date:2008-01-29
Last Update Date:2020-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X101Y00000X
175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist
No101Y00000XBehavioral Health & Social Service ProvidersCounselor