Healthcare Provider Details

I. General information

NPI: 1649932922
Provider Name (Legal Business Name): MARIA SUSANA MARTINEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2021
Last Update Date: 10/13/2021
Certification Date: 10/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

629 HAMPTON RD
HAYWARD CA
94541-1417
US

IV. Provider business mailing address

18540 MADISON AVE
CASTRO VALLEY CA
94546-1640
US

V. Phone/Fax

Practice location:
  • Phone: 510-921-2234
  • Fax:
Mailing address:
  • Phone: 510-921-2234
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376G00000X
TaxonomyNursing Home Administrator
License Number019200327
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: