Healthcare Provider Details

I. General information

NPI: 1174743314
Provider Name (Legal Business Name): MARTA SARMIENTO, M.D.,INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/30/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

725 W LA VETA AVE #200
ORANGE CA
92868-4403
US

IV. Provider business mailing address

725 W LA VETA AVE #200
ORANGE CA
92868-4403
US

V. Phone/Fax

Practice location:
  • Phone: 714-771-2229
  • Fax: 714-771-1108
Mailing address:
  • Phone: 714-771-2229
  • Fax: 714-771-1108

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberG54215
License Number StateCA

VIII. Authorized Official

Name: DR. MARTA SARITA SARMIENTO
Title or Position: PRESIDENT
Credential: M.D.
Phone: 714-771-2229