Healthcare Provider Details

I. General information

NPI: 1215848783
Provider Name (Legal Business Name): GEMA ANGELICA MARTINEZ CASTRO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2026
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

983 SONOMA AVE
SANTA ROSA CA
95404-4818
US

IV. Provider business mailing address

2235 MERCURY WAY STE 107
SANTA ROSA CA
95407-5472
US

V. Phone/Fax

Practice location:
  • Phone: 707-575-4357
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: