Thais Dinese St Martin, MASTERS OF SCIENCE

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

12260 Issued in CA

Practice address

12335 Woodside Ave
Lakeside, CA 92040

Phone

(619) 390-2391

NPI assigned

Jul 15, 2019

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Miss Thais Dinese Johnson Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1563148800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1563148800000",
    "number": "1134771512",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10180 OBRIEN PL",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921242922",
            "telephone_number": "714-293-0033"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12335 WOODSIDE AVE",
            "city": "LAKESIDE",
            "state": "CA",
            "postal_code": "92040",
            "telephone_number": "619-390-2391"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ST MARTIN",
        "first_name": "THAIS",
        "middle_name": "DINESE",
        "name_prefix": "Mrs.",
        "credential": "MASTERS OF SCIENCE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-07-15",
        "last_updated": "2019-07-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "CA",
            "license": "12260",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "THAIS",
            "last_name": "JOHNSON",
            "middle_name": "DINESE",
            "prefix": "MISS",
            "credential": "MASTERS OF SCIENCE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Ivan Jonathan Santos, DDS
• Lindsey Michelle Shamp
• Tabitha Shannon, RN
• Steve Chia-Hua Shiue, MD
• Sean Arthur Smith
• Ryle Stous
• Sunroot Psychiatric Wellness, a Professional Nursing Corporation
• Raydina Louise Swan
• Sarah Elizabeth Swift, PSY.D.
• Fei Tanaka, LMFT

• Speech-Language Pathologist in Lakeside, CA
• Providers in Lakeside, CA by specialty
• Speech-Language Pathologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 15, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.