Provider Demographics
NPI:1053850883
Name:MARTINEZ VERDUGO, CRIS
Entity type:Individual
Prefix:
First Name:CRIS
Middle Name:
Last Name:MARTINEZ VERDUGO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8836 S VERMONT AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90044-4832
Mailing Address - Country:US
Mailing Address - Phone:323-921-8803
Mailing Address - Fax:
Practice Address - Street 1:8836 S VERMONT AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90044-4832
Practice Address - Country:US
Practice Address - Phone:323-593-5300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-13
Last Update Date:2025-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACATC #174380I101YA0400X
373H00000X, 172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No373H00000XNursing Service Related ProvidersDay Training/Habilitation Specialist