Provider Demographics
NPI:1386205144
Name:MARTIN, LIZZETTE (HA8272)
Entity Type:Individual
Prefix:
First Name:LIZZETTE
Middle Name:
Last Name:MARTIN
Suffix:
Gender:F
Credentials:HA8272
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:255 E BONITA AVE
Mailing Address - Street 2:
Mailing Address - City:POMONA
Mailing Address - State:CA
Mailing Address - Zip Code:91767
Mailing Address - Country:US
Mailing Address - Phone:909-450-0304
Mailing Address - Fax:909-450-0345
Practice Address - Street 1:255 E BONITA AVE
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91767
Practice Address - Country:US
Practice Address - Phone:909-450-0304
Practice Address - Fax:909-450-0345
Is Sole Proprietor?:No
Enumeration Date:2019-06-24
Last Update Date:2019-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAHA8272237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist