Basic Information
| Provider Information | |||||||||
| NPI: | 1093138091 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ALAS MARTINEZ | ||||||||
| FirstName: | IMELDA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 921 E COMPTON BLVD | ||||||||
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| City: | COMPTON | ||||||||
| State: | CA | ||||||||
| PostalCode: | 902213303 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3106686800 | ||||||||
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| Practice Location | |||||||||
| Address1: | 14911 ORIZABA AVE | ||||||||
| Address2: | |||||||||
| City: | PARAMOUNT | ||||||||
| State: | CA | ||||||||
| PostalCode: | 907233534 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5627147201 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/27/2014 | ||||||||
| LastUpdateDate: | 08/31/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 08/31/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 97556 | CA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.