Basic Information
| Provider Information | |||||||||
| NPI: | 1629690466 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MARTINEZ | ||||||||
| FirstName: | JASMIN | ||||||||
| MiddleName: | LUCIA | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | AUD. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 30055 NORTHWESTERN HWY STE 101 | ||||||||
| Address2: | |||||||||
| City: | FARMINGTON HILLS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 483343260 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2488654166 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 30055 NORTHWESTERN HWY STE 101 | ||||||||
| Address2: | |||||||||
| City: | FARMINGTON HILLS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 483343260 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2488654444 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/14/2020 | ||||||||
| LastUpdateDate: | 10/18/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/18/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 231H00000X | MI | Y | Speech, Language and Hearing Service Providers | Audiologist |
No ID Information.