Individual provider Active NPI

Widalys Garcia-Martinez

  • Speech-Language Pathologist
  • Kissimmee, FL
National Provider Identifier
1164907747
Registry record updated Sep 28, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
License
8545 Issued in FL
Practice address
1107 Mabbette St
Kissimmee, FL 34741-5161
Phone
(407) 201-8079
Fax
(407) 343-9180
NPI assigned
Sep 28, 2018
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 28, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Speech-Language Pathologist 235Z00000X 8545 FL Primary

Addresses

Primary practice location

1107 Mabbette St
Kissimmee, FL 34741-5161

Mailing address

7667 N Wickham Rd
Apt # 1205
Melbourne, FL 32940
Phone (787) 617-2969

Other identifiers 1

IdentifierTypeStateIssuer
8545OtherFLDEPARTMENT OF HEALTH- DIVISION OF MEDICAL QUALITY ASSURANCE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Yakety Yak Speech-Language Pathologists, Inc. Speech-Language Pathologist PastSince Jul 31, 2022 Accepting new patients
Yakety Yak Speech-Language Pathologists, Inc. Speech-Language Pathologist Past Accepting new patients

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1538092800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1538092800000",
    "number": "1164907747",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7667 N WICKHAM RD",
            "address_2": "APT # 1205",
            "city": "MELBOURNE",
            "state": "FL",
            "postal_code": "32940",
            "telephone_number": "787-617-2969"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1107 MABBETTE ST",
            "city": "KISSIMMEE",
            "state": "FL",
            "postal_code": "347415161",
            "telephone_number": "407-201-8079",
            "fax_number": "407-343-9180"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GARCIA-MARTINEZ",
        "first_name": "WIDALYS",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-09-28",
        "last_updated": "2018-09-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "FL",
            "license": "8545",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DEPARTMENT OF HEALTH- DIVISION OF MEDICAL QUALITY ASSURANCE",
            "identifier": "8545",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Kissimmee, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 28, 2018; 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.