Provider Demographics
NPI:1528878436
Name:MARTINEZ, MARICELA J (BACHELOR)
Entity type:Individual
Prefix:MISS
First Name:MARICELA
Middle Name:J
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:BACHELOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1615 BRANDEE LN
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95403-8608
Mailing Address - Country:US
Mailing Address - Phone:951-291-3470
Mailing Address - Fax:
Practice Address - Street 1:1615 BRANDEE LN
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95403-8608
Practice Address - Country:US
Practice Address - Phone:951-291-3470
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-13
Last Update Date:2025-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA72292355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant