Healthcare Provider Details

I. General information

NPI: 1952932394
Provider Name (Legal Business Name): MARTINA GRZMOT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/03/2020
Last Update Date: 10/17/2024
Certification Date: 10/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 VICENTE ST
SAN FRANCISCO CA
94116-2923
US

IV. Provider business mailing address

2211 POST ST STE 300
SAN FRANCISCO CA
94115-3442
US

V. Phone/Fax

Practice location:
  • Phone: 415-681-3211
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number133017
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: