Provider Demographics
NPI:1316193444
Name:MARTINEZ, SANDRA ISABEL (SLP-CFY)
Entity Type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:ISABEL
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:SLP-CFY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:729 N. 77 SUNSHINE STRIP
Mailing Address - Street 2:
Mailing Address - City:HARLINGEN
Mailing Address - State:TX
Mailing Address - Zip Code:78550-8847
Mailing Address - Country:US
Mailing Address - Phone:956-421-4667
Mailing Address - Fax:956-421-2016
Practice Address - Street 1:729 N. 77 SUNSHINE STRIP
Practice Address - Street 2:
Practice Address - City:HARLINGEN
Practice Address - State:TX
Practice Address - Zip Code:78550-8847
Practice Address - Country:US
Practice Address - Phone:956-421-4667
Practice Address - Fax:956-421-2016
Is Sole Proprietor?:No
Enumeration Date:2008-08-08
Last Update Date:2008-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX104149235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX021738201Medicaid