Provider Demographics
NPI:1811570997
Name:MARTINEZ, MARIA LUPITA (HAD)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:LUPITA
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:HAD
Other - Prefix:
Other - First Name:MARIA
Other - Middle Name:LUPITA
Other - Last Name:ROBINSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5555 GARDEN GROVE BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CA
Mailing Address - Zip Code:92683-8234
Mailing Address - Country:US
Mailing Address - Phone:714-898-5732
Mailing Address - Fax:
Practice Address - Street 1:19520 NORDHOFF ST STE 5
Practice Address - Street 2:
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91324-2451
Practice Address - Country:US
Practice Address - Phone:714-898-5732
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-05
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAHA8649237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA8649OtherSPEECH-LANGUAGE PATHOLOGY AND AUDIOLOGY AND HEARING AID DISPENSERS BOARD