Kassandra Martinez
Student in an Organized Health Care Education/Training Program in San Diego, CA. Individual provider (NPI-1).
NPI number1124642020
StatusActive
Last updated in NPPESJun 5, 2020
Details
- NPI
- 1124642020
- Entity type
- Individual (NPI-1)
- Name
- Miss Kassandra Martinez
- Sex
- Female
- Sole proprietor
- No
- Enumeration date
- Jun 5, 2020
- Certification date
- Jun 5, 2020
- Last updated
- Jun 5, 2020
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 390200000X | Student in an Organized Health Care Education/Training Program | – | – | Yes |
| 103T00000X | Psychologist | – | – |
Practice location
3020 Childrens Way # Mc5018San Diego, CA 92123-4223
Phone 858-966-5832
Mailing address
3869 Miramar St # 2211La Jolla, CA 92037-1303
Phone 915-667-0411
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