Healthcare Provider Details

I. General information

NPI: 1609790724
Provider Name (Legal Business Name): OLIVIA MARTINEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/10/2026
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3441 W VALENCIA DR
FULLERTON CA
92833-3131
US

IV. Provider business mailing address

3441 W VALENCIA DR
FULLERTON CA
92833-3131
US

V. Phone/Fax

Practice location:
  • Phone: 714-447-7500
  • Fax: 714-447-7793
Mailing address:
  • Phone: 714-447-7500
  • Fax: 714-447-7793

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number14096929
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: