Provider Demographics
NPI:1013246339
Name:MARTINEZ, ELENA F (MA CCC SLP)
Entity Type:Individual
Prefix:
First Name:ELENA
Middle Name:F
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:MA CCC SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4357 CLEVELAND AVE
Mailing Address - Street 2:UNIT 103
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-2495
Mailing Address - Country:US
Mailing Address - Phone:307-760-9342
Mailing Address - Fax:
Practice Address - Street 1:15347 MATURIN DR
Practice Address - Street 2:UNIT 106
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92127-2302
Practice Address - Country:US
Practice Address - Phone:307-760-9342
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-15
Last Update Date:2011-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP 14517235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist