Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 175L00000X | Homeopath | 10544001 | TX |
NPI | 1700446796 |
---|---|
Provider Name | Letha Martin |
First Address | Chandler, AZ 85286-7075 |
Second Address | Chandler, AZ 85248-3763 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/06/2019 |
Last Update Date | 23/03/2020 |