Provider Demographics
NPI:1639570385
Name:MARTINEZ, STEPHANIE MARIZA (BS, EIS)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:MARIZA
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:BS, EIS
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:MARIZA
Other - Last Name:CORONA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BS,EIS
Mailing Address - Street 1:320 CUSTER RD
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75080-5623
Mailing Address - Country:US
Mailing Address - Phone:972-490-9055
Mailing Address - Fax:972-490-9058
Practice Address - Street 1:320 CUSTER RD
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080-5623
Practice Address - Country:US
Practice Address - Phone:972-490-9055
Practice Address - Fax:972-490-9058
Is Sole Proprietor?:No
Enumeration Date:2014-09-12
Last Update Date:2015-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
No171M00000XOther Service ProvidersCase Manager/Care Coordinator