Provider Demographics
NPI:1477043792
Name:MARTINEZ, LETICIA FEDERICO
Entity type:Individual
Prefix:
First Name:LETICIA
Middle Name:FEDERICO
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 1:1115 E FLORENCE BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:CASA GRANDE
Mailing Address - State:AZ
Mailing Address - Zip Code:85122-4228
Mailing Address - Country:US
Mailing Address - Phone:520-723-4429
Mailing Address - Fax:
Practice Address - Street 1:1115 E FLORENCE BLVD STE A
Practice Address - Street 2:
Practice Address - City:CASA GRANDE
Practice Address - State:AZ
Practice Address - Zip Code:85122-4228
Practice Address - Country:US
Practice Address - Phone:520-836-4278
Practice Address - Fax:520-836-1786
Is Sole Proprietor?:No
Enumeration Date:2018-05-11
Last Update Date:2025-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-16740101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health