1386443265 NPI number — COGNITIVE FUNCTION DEVELOPMENT INSTITUTE, INC.

Table of content: JUAN RICARDO MARTINEZ SR. B.S. SLP/AUD (NPI 1700202645)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386443265 NPI number — COGNITIVE FUNCTION DEVELOPMENT INSTITUTE, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COGNITIVE FUNCTION DEVELOPMENT INSTITUTE, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1386443265
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/12/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6895 E LYNX WAGON RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PRESCOTT VALLEY
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
86314-1932
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
507-251-0851
Provider Business Mailing Address Fax Number:
928-515-2278

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
COGNITIVE FUNCTION DEVELOPMENT INSTITUTE
Provider Second Line Business Practice Location Address:
3250 GATEWAY BLVD, SUITE 200
Provider Business Practice Location Address City Name:
PRESCOTT
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
86303
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
507-251-0851
Provider Business Practice Location Address Fax Number:
928-515-2278
Provider Enumeration Date:
03/12/2025

Additional Information

Authorized Official

Authorized Official Last Name:
BEYST
Authorized Official First Name:
BRIAN
Authorized Official Middle Name:
Authorized Official Title or Position:
CFO / DIRECTOR OF R&D
Authorized Official Telephone Number:
507-251-0851

Provider Taxonomy Codes

  • Taxonomy code: 261QM0801X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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