Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0401X | Family Doctor - Addiction Medicine | G38355 | CA |
NPI | 1073703682 |
---|---|
Provider Name | Judith Ann Martin |
First Address | Oakland, CA 94606-4331 |
Second Address | Oakland, CA 94606-4331 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/07/2007 |
Last Update Date | 30/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F13889 | (02) | CA |