Healthcare Provider Details

I. General information

NPI: 1346314291
Provider Name (Legal Business Name): MARTA K WASIAK MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/20/2006
Last Update Date: 11/26/2024
Certification Date: 11/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 CONCORD AVE
CHICO CA
95928-9487
US

IV. Provider business mailing address

1601 CONCORD AVE
CHICO CA
95928-9487
US

V. Phone/Fax

Practice location:
  • Phone: 530-879-5000
  • Fax: 352-351-9495
Mailing address:
  • Phone: 530-879-5000
  • Fax: 352-351-9495

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License NumberME82006
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberME82006
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberME82006
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: