Provider Demographics
NPI:1467949289
Name:MARTYNOVA, ANASTASIYA (AUD)
Entity Type:Individual
Prefix:
First Name:ANASTASIYA
Middle Name:
Last Name:MARTYNOVA
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:ANASTASIYA
Other - Middle Name:
Other - Last Name:PEREVERZEVA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:325 DISTEL CIR
Mailing Address - Street 2:
Mailing Address - City:LOS ALTOS
Mailing Address - State:CA
Mailing Address - Zip Code:94022-1408
Mailing Address - Country:US
Mailing Address - Phone:925-875-6529
Mailing Address - Fax:
Practice Address - Street 1:4050 DUBLIN BLVD
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:CA
Practice Address - Zip Code:94568-3112
Practice Address - Country:US
Practice Address - Phone:925-875-6529
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-17
Last Update Date:2021-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist