Provider Demographics
NPI:1841554243
Name:MARTINEZ, ADRIANA ALICIA
Entity type:Individual
Prefix:
First Name:ADRIANA
Middle Name:ALICIA
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ADRIANA
Other - Middle Name:ALICIA
Other - Last Name:CAVAZOS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:622 S 6TH ST
Mailing Address - Street 2:
Mailing Address - City:KINGSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78363-5523
Mailing Address - Country:US
Mailing Address - Phone:956-222-8204
Mailing Address - Fax:
Practice Address - Street 1:622 S 6TH ST
Practice Address - Street 2:
Practice Address - City:KINGSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78363-5523
Practice Address - Country:US
Practice Address - Phone:956-222-8204
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-29
Last Update Date:2022-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX107366235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX107366OtherSTATE LICENSE