Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207SG0201X | Clinical Genetics (M.D.) | 233551 | MA |
Y | 208000000X | Pediatrician | 233551 | MA |
NPI | 1053539015 |
---|---|
Provider Name | Dr. Madelena Michele Martin |
First Address | Sacramento, CA 95817-2310 |
Second Address | Sacramento, CA 95817-2310 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/04/2007 |
Last Update Date | 12/04/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H83633 | (02) | CA |