Provider Demographics
NPI:1811292758
Name:MARTINEZ GONZALEZ, LIZ (MS, SLP)
Entity type:Individual
Prefix:
First Name:LIZ
Middle Name:
Last Name:MARTINEZ GONZALEZ
Suffix:
Gender:F
Credentials:MS, SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:URB. LOS SAUCE
Mailing Address - Street 2:CALLE LAUREL CASA 106
Mailing Address - City:HUMACAO
Mailing Address - State:PR
Mailing Address - Zip Code:00791
Mailing Address - Country:US
Mailing Address - Phone:787-852-0364
Mailing Address - Fax:
Practice Address - Street 1:URB. LOS SAUCE
Practice Address - Street 2:CALLE LAUREL CASA 106
Practice Address - City:HUMACAO
Practice Address - State:PR
Practice Address - Zip Code:00791
Practice Address - Country:US
Practice Address - Phone:787-852-0364
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-25
Last Update Date:2020-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1006235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR1006OtherM.S,.SLP