1689777500 NPI number — MS. MARY HELEN MARTINEZ MA, SLP/CCC

Table of content: MS. MARY HELEN MARTINEZ MA, SLP/CCC (NPI 1689777500)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689777500 NPI number — MS. MARY HELEN MARTINEZ MA, SLP/CCC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MARTINEZ
Provider First Name:
MARY
Provider Middle Name:
HELEN
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MA, SLP/CCC
Provider Gender Code:
F

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:
1689777500
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/24/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
166 BARBARA BND
Provider Second Line Business Mailing Address:
APT/SUITE
Provider Business Mailing Address City Name:
UNIVERSAL CITY
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78148-3602
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
210-508-5298
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1248 AUSTIN HWY
Provider Second Line Business Practice Location Address:
SUITE 210
Provider Business Practice Location Address City Name:
SAN ANTONIO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78209-4821
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-646-8008
Provider Business Practice Location Address Fax Number:
210-646-8242
Provider Enumeration Date:
09/06/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 235Z00000X , with the licence number:  14576 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 86087T . This is a "BCBS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 75285003678239A002 . This is a "TRICARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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