Healthcare Provider Details

I. General information

NPI: 1346616620
Provider Name (Legal Business Name): CORI LAINA MARTIN-SIEBERT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/20/2015
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1724 LAUREL RD
OCEANSIDE CA
92054-6150
US

IV. Provider business mailing address

1724 LAUREL RD
OCEANSIDE CA
92054-6150
US

V. Phone/Fax

Practice location:
  • Phone: 760-822-2674
  • Fax:
Mailing address:
  • Phone: 760-822-2674
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number22105
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: