Healthcare Provider Details

I. General information

NPI: 1528842606
Provider Name (Legal Business Name): MARTINA MARIE SHUBERT NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2023
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

683 LOMAS SANTA FE DR
SOLANA BEACH CA
92075-1412
US

IV. Provider business mailing address

1485 LEAF TER
SAN DIEGO CA
92114-6820
US

V. Phone/Fax

Practice location:
  • Phone: 619-400-5495
  • Fax:
Mailing address:
  • Phone: 856-313-1946
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95026602
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: