Healthcare Provider Details

I. General information

NPI: 1568301349
Provider Name (Legal Business Name): MARTHIE FHAYE TRAZO MA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2026
Last Update Date: 03/26/2026
Certification Date: 03/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 MARKET ST
SAN FRANCISCO CA
94103-1509
US

IV. Provider business mailing address

1111 MARKET ST
SAN FRANCISCO CA
94103-1509
US

V. Phone/Fax

Practice location:
  • Phone: 415-425-7477
  • Fax: 415-425-7477
Mailing address:
  • Phone: 415-425-7477
  • Fax: 415-425-7477

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberCMAC-9880
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: