Provider Demographics
NPI:1871104307
Name:MARTIN-LANG, ERANIA MARIE (MA)
Entity type:Individual
Prefix:
First Name:ERANIA
Middle Name:MARIE
Last Name:MARTIN-LANG
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13329 ARBOR PARK LN
Mailing Address - Street 2:
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92553-6916
Mailing Address - Country:US
Mailing Address - Phone:951-489-7971
Mailing Address - Fax:
Practice Address - Street 1:13329 ARBOR PARK LN
Practice Address - Street 2:
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92553-6916
Practice Address - Country:US
Practice Address - Phone:951-489-7971
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-10
Last Update Date:2020-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAC2823545OtherDRIVERS LICENSE
CAC2823545Medicaid