Provider Demographics
NPI:1295621175
Name:MARTINEZ, JOHNNY (CDAC A060511021)
Entity type:Individual
Prefix:
First Name:JOHNNY
Middle Name:
Last Name:MARTINEZ
Suffix:
Gender:M
Credentials:CDAC A060511021
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12622 WOODLAND LN
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92840-5509
Mailing Address - Country:US
Mailing Address - Phone:949-922-9906
Mailing Address - Fax:
Practice Address - Street 1:12622 WOODLAND LN
Practice Address - Street 2:
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92840-5509
Practice Address - Country:US
Practice Address - Phone:949-922-9906
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-16
Last Update Date:2025-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA060511021101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)