Healthcare Provider Details

I. General information

NPI: 1457571697
Provider Name (Legal Business Name): MARTA SARITA SARMIENTO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARTA SARITA VALDIVIESO SARMIENTO M.D.

II. Dates (important events)

Enumeration Date: 04/30/2007
Last Update Date: 01/07/2021
Certification Date: 01/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

725 W LA VETA AVE STE 240
ORANGE CA
92868-4446
US

IV. Provider business mailing address

725 W LA VETA AVE STE 240
ORANGE CA
92868-4446
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:
Title or Position:
Credential:
Phone: