MEDICARE: MARTINE HENRIQUEZ

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	06568	MD

General Provider Information

NPI Number	:	1053478404
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARTINE HENRIQUEZ

Provider Business Mailing Address
First Line	:	4922 LASALLE RD
Second Line	:
City	:	HYATTSVILLE
State	:	MD
Zip	:	20782-3302
Country	:	US
Telephone Number	:	301-864-2333
Fax Number	:

Provider Business Practice Location Address
First Line	:	4922 LASALLE RD
Second Line	:
City	:	HYATTSVILLE
State	:	MD
Zip	:	20782-3302
Country	:	US
Telephone Number	:	301-864-2333
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/03/2007
Last Update Date	:	06/09/2015

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Directions to “ MARTINE HENRIQUEZ ” Practice Location

Language	Start Address	Practice Location

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