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NPI Code Detail

MEDICARE: MRS. KIESHA TIRIS MARTINEZ-SCOTT SLP

MEDICARE: MRS. KIESHA TIRIS MARTINEZ-SCOTT 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 Pathologist18683CA

General Provider Information

NPI Number : 1942556626
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. KIESHA TIRIS MARTINEZ-SCOTT SLP
Provider Business Mailing Address
First Line : 3521 LOMITA BLVD STE 201
Second Line :
City : TORRANCE
State : CA
Zip : 90505-5040
Country : US
Telephone Number : 310-856-8528
Fax Number : 310-856-8532
Provider Business Practice Location Address
First Line : 3521 LOMITA BLVD STE 201
Second Line :
City : TORRANCE
State : CA
Zip : 90505-5040
Country : US
Telephone Number : 310-856-8528
Fax Number : 310-856-8532
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/31/2012
Last Update Date : 07/31/2012

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Directions to “ MRS. KIESHA TIRIS MARTINEZ-SCOTT SLP” Practice Location

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