Healthcare Provider Details

I. General information

NPI: 1295871549
Provider Name (Legal Business Name): MISS MARTINA VENDITELLI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2007
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 N. CARLISLE AVE
SOMERTON AZ
85350
US

IV. Provider business mailing address

1523 W 12TH LN
YUMA AZ
85364-8908
US

V. Phone/Fax

Practice location:
  • Phone: 928-341-6046
  • Fax:
Mailing address:
  • Phone: 408-506-8515
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: