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NPI Code Detail

MEDICARE: MS. PAMELA MARTINEZ MS,CCC-SLP

MEDICARE:  MS. PAMELA  MARTINEZ  MS,CCC-SLP
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
1235Z00000XSpeech-Language Pathologist1730NM

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1578788063
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. PAMELA MARTINEZ MS,CCC-SLP
Provider Business Mailing Address
First Line : 863 SPERRY DR
Second Line :
City : LAS VEGAS
State : NM
Zip : 87701-5028
Country : US
Telephone Number : 505-426-2669
Fax Number :
Provider Business Practice Location Address
First Line : 179 BRIDGE ST
Second Line :
City : LAS VEGAS
State : NM
Zip : 87701-3495
Country : US
Telephone Number : 505-426-2554
Fax Number : 505-426-2782
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/17/2007
Last Update Date : 07/08/2007

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Directions to “ MS. PAMELA MARTINEZ MS,CCC-SLP” Practice Location

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