Provider Demographics
NPI:1861949414
Name:MARTINEZ, SASHA (PHD)
Entity type:Individual
Prefix:
First Name:SASHA
Middle Name:
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:675 S. CUEVAS BUSTAMANTE
Mailing Address - Street 2:BOX 44
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00918-5200
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:675 S. CUEVAS BUSTAMANTE
Practice Address - Street 2:BOX 44
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918-5200
Practice Address - Country:US
Practice Address - Phone:787-624-6888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-01
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR005689103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist