Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 275913 | CA |
NPI | 1003064080 |
---|---|
Provider Name | Miss Martha Emily Muriel |
First Address | Los Angeles, CA 90007-3304 |
Second Address | Los Angeles, CA 90007-3304 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/09/2008 |
Last Update Date | 03/09/2008 |