MEDICARE: JENNIFER ANN MARTIN

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	10692	CA

General Provider Information

NPI Number	:	1316689946
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER ANN MARTIN

Provider Business Mailing Address
First Line	:	PO BOX 720403
Second Line	:
City	:	PINON HILLS
State	:	CA
Zip	:	92372-0403
Country	:	US
Telephone Number	:	760-964-8156
Fax Number	:

Provider Business Practice Location Address
First Line	:	1427 ARCADIA ROAD
Second Line	:
City	:	PINON HILLS
State	:	CA
Zip	:	92372
Country	:	US
Telephone Number	:	760-964-8156
Fax Number	:

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

Provider Enumeration Date	:	04/13/2022
Last Update Date	:	04/13/2022

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Directions to “ JENNIFER ANN MARTIN ” Practice Location

Language	Start Address	Practice Location

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