Healthcare Provider Details

I. General information

NPI: 1588162101
Provider Name (Legal Business Name): MARIBEL ORTIZ MARTINEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARIBEL ORTIZ

II. Dates (important events)

Enumeration Date: 01/29/2018
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

645 WOOL CREEK DR
SAN JOSE CA
95112-2617
US

IV. Provider business mailing address

336 MCCOVEY LN
SAN JOSE CA
95127-3441
US

V. Phone/Fax

Practice location:
  • Phone: 408-283-6000
  • Fax:
Mailing address:
  • Phone: 408-708-7972
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number18694
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: