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General NPI Number Information
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NPI Number | 1902721558
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Entity Type | Individual
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Provider Name | GINA MARTINEZ
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Gender | Female
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Dates
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Enumeration Date | 08/12/2026
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Last Update Date | 08/12/2026
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Provider Practice Location Address
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Address Line | 1629 HOLLY OAK ST
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City | LA VERNE
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State | CA
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Zip | 91750-3914
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Country | US
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Telephone | 909-971-8200
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Fax |
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Provider Business Mailing Address
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Address Line | 941 MALAKOFF RD
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City | SAN DIMAS
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State | CA
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Zip | 91773-1554
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Country | US
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Telephone | 909-239-7782
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 26166
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License Number State | CA
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