Provider Demographics
NPI:1902864655
Name:MARTINEZ, STEPHEN (AUD PHD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:
Last Name:MARTINEZ
Suffix:
Gender:M
Credentials:AUD PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3605 LONG BEACH BLVD., STE. #110
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90807-4013
Mailing Address - Country:US
Mailing Address - Phone:562-989-8101
Mailing Address - Fax:562-989-8119
Practice Address - Street 1:3605 LONG BEACH BLVD., STE. #110
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90807-4013
Practice Address - Country:US
Practice Address - Phone:562-989-8101
Practice Address - Fax:562-989-8119
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2013-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAU1232237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAU0012320Medicaid
CAAUD1232AMedicare ID - Type Unspecified
CAAU0012320Medicaid