Provider Demographics
NPI:1669973624
Name:MARTINEZ VALADEZ, LIZETH GEOVANNI
Entity type:Individual
Prefix:MS
First Name:LIZETH
Middle Name:GEOVANNI
Last Name:MARTINEZ VALADEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:LIZ
Other - Middle Name:
Other - Last Name:MARTINEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2975 MCMILLAN AVE STE 164
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401-6768
Mailing Address - Country:US
Mailing Address - Phone:805-439-4890
Mailing Address - Fax:805-439-4891
Practice Address - Street 1:2975 MCMILLAN AVE STE 164
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-6768
Practice Address - Country:US
Practice Address - Phone:805-439-4890
Practice Address - Fax:805-439-4891
Is Sole Proprietor?:No
Enumeration Date:2018-02-26
Last Update Date:2025-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA174H00000X, 225400000X
106S00000X, 171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner
No174H00000XOther Service ProvidersHealth Educator
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No171M00000XOther Service ProvidersCase Manager/Care Coordinator