Healthcare Provider Details

I. General information

NPI: 1831678465
Provider Name (Legal Business Name): MARTINA NUHU KASHALLA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/14/2018
Last Update Date: 07/28/2023
Certification Date: 07/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405 E BUENA VISTA ST
BARSTOW CA
92311-2815
US

IV. Provider business mailing address

405 E BUENA VISTA ST
BARSTOW CA
92311-2815
US

V. Phone/Fax

Practice location:
  • Phone: 818-895-3100
  • Fax:
Mailing address:
  • Phone: 818-895-3100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95009537
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: