MEDICARE: DONNA CATHLEEN MALLARI MARTINEZ NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	95038578	CA
2	363LF0000X	Family Nurse Practitioner	883048	NV

General Provider Information

NPI Number	:	1154270494
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DONNA CATHLEEN MALLARI MARTINEZ NP

Provider Business Mailing Address
First Line	:	6137 WADDINGTON WAY
Second Line	:
City	:	ROSEVILLE
State	:	CA
Zip	:	95747-4550
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6137 WADDINGTON WAY
Second Line	:
City	:	ROSEVILLE
State	:	CA
Zip	:	95747-4550
Country	:	US
Telephone Number	:	510-512-8274
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/28/2026
Last Update Date	:	02/16/2026

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