Provider Demographics
NPI:1588104251
Name:MARTINEZ, PRISCILLA (SLP)
Entity type:Individual
Prefix:
First Name:PRISCILLA
Middle Name:
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24600 SILVER CLOUD CT
Mailing Address - Street 2:
Mailing Address - City:MONTEREY
Mailing Address - State:CA
Mailing Address - Zip Code:93940-6582
Mailing Address - Country:US
Mailing Address - Phone:831-645-7900
Mailing Address - Fax:
Practice Address - Street 1:8030 SOQUEL AVE STE 100
Practice Address - Street 2:
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95062-2096
Practice Address - Country:US
Practice Address - Phone:831-645-7900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-01
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19057235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist