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General NPI Number Information
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NPI Number | 1972775484
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Entity Type | Individual
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Provider Name | STELLA F MARTINEZ CLINICAL FELLOW
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Gender | Female
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Dates
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Enumeration Date | 03/25/2008
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Last Update Date | 03/25/2008
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Provider Practice Location Address
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Address Line | 714 CALLE DON DIEGO
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City | ESPANOLA
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State | NM
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Zip | 87532-3414
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Country | US
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Telephone | 505-367-3342
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 882
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City | SANTA CRUZ
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State | NM
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Zip | 87567-0882
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Country | US
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Telephone | 505-927-2025
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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 | C-4218
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License Number State | AZ
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