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NPI Code Detail

MEDICARE: RILEY W MARTIN

MEDICARE: RILEY W 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
1235Z00000XSpeech-Language Pathologist

General Provider Information

NPI Number : 1639867971
Entity Type Code : Individual
Provider Name (Legal Business Name) : RILEY W MARTIN
Provider Business Mailing Address
First Line : 4441 ARCH ST
Second Line :
City : SAN DIEGO
State : CA
Zip : 92116-1002
Country : US
Telephone Number : 615-708-3993
Fax Number :
Provider Business Practice Location Address
First Line : 1415 RIDGEBACK RD STE 21
Second Line :
City : CHULA VISTA
State : CA
Zip : 91910-6984
Country : US
Telephone Number : 619-207-0984
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/25/2023
Last Update Date : 12/09/2025

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Directions to “ RILEY W MARTIN ” Practice Location

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