Provider Demographics
NPI:1497322853
Name:MARTINEZ-VALDIVIESO, LORENA SOFIA
Entity Type:Individual
Prefix:
First Name:LORENA
Middle Name:SOFIA
Last Name:MARTINEZ-VALDIVIESO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 CALLE PRINCESA CRISTINA
Mailing Address - Street 2:
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00969-5335
Mailing Address - Country:US
Mailing Address - Phone:787-608-6520
Mailing Address - Fax:
Practice Address - Street 1:117 CALLE PRINCESA CRISTINA
Practice Address - Street 2:
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00969-5335
Practice Address - Country:US
Practice Address - Phone:787-608-6520
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-04
Last Update Date:2021-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR004322235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty