Healthcare Provider Details

I. General information

NPI: 1457523359
Provider Name (Legal Business Name): GINA MARTINEZ MEDINA N.P
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2008
Last Update Date: 03/31/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 PHELAN AVE
SAN FRANCISCO CA
94112-1821
US

IV. Provider business mailing address

3502 SANFORD ST
CONCORD CA
94520-1513
US

V. Phone/Fax

Practice location:
  • Phone: 415-239-3110
  • Fax:
Mailing address:
  • Phone: 925-363-7369
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number17626
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: