MEDICARE: MARISSA ELAINE MARTINEZ

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2355S0801X	Speech-Language Assistant	10191	CA

General Provider Information

NPI Number	:	1558205526
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARISSA ELAINE MARTINEZ

Provider Business Mailing Address
First Line	:	9455 HOMAGE AVE
Second Line	:
City	:	WHITTIER
State	:	CA
Zip	:	90603-1932
Country	:	US
Telephone Number	:	562-693-5449
Fax Number	:

Provider Business Practice Location Address
First Line	:	12411 SLAUSON AVE
Second Line	:
City	:	WHITTIER
State	:	CA
Zip	:	90606-2835
Country	:	US
Telephone Number	:	562-693-5449
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/17/2026
Last Update Date	:	04/17/2026

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Directions to “ MARISSA ELAINE MARTINEZ ” Practice Location

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