Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YM0800X | Mental Health Counselor |
NPI | 1003215880 |
---|---|
Provider Name | Cynthia Marie Martinez |
First Address | San Jose, CA 95127-4721 |
Second Address | San Jose, CA 95112-4706 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/08/2014 |
Last Update Date | 13/10/2021 |