Renegade Love Marriage and Intimacy Therapy Professional Corporation

Primary specialty

Marriage & Family TherapistTaxonomy code 106H00000X

Legal business name

RENEGADE LOVE MARRIAGE AND INTIMACY THERAPY PROFESSIONAL CORPORATION

Practice address

13340 W Washington Blvd
Los Angeles, CA 90066-5108

Phone

(714) 454-3072

NPI assigned

Aug 28, 2024

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Alexus Martinez, PHD, LMFT, CSTNPI 1467092403

Title

Ceo

Phone

(714) 454-3072

Specialties & licenses 1

Addresses

Other names 1

• Renegade Love Therapy Doing business as

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Alexus Martinez

  • Marriage & Family Therapist
  • Canoga Park, CA
  • NPI 1467092403
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1724803200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1724803200000",
    "number": "1285468611",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13340 W WASHINGTON BLVD",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900665108",
            "telephone_number": "714-454-3072"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13340 W WASHINGTON BLVD",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900665108",
            "telephone_number": "714-454-3072"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RENEGADE LOVE MARRIAGE AND INTIMACY THERAPY PROFESSIONAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-08-28",
        "last_updated": "2024-08-28",
        "certification_date": "2024-08-28",
        "status": "A",
        "authorized_official_last_name": "MARTINEZ",
        "authorized_official_first_name": "ALEXUS",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "714-454-3072",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHD, LMFT, CST"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Marriage & Family Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Renegade Love Therapy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Marriage & Family Therapist in Los Angeles, CA
• Providers in Los Angeles, CA by specialty
• Marriage & Family Therapist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 28, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.