Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | 95002892 | CA |
NPI | 1013373398 |
---|---|
Provider Name | Danielle Merchant Martin |
First Address | Wildomar, CA 92595-9549 |
Second Address | Wildomar, CA 92595-9549 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/01/2016 |
Last Update Date | 18/12/2018 |