Healthcare Provider Details

I. General information

NPI: 1710987888
Provider Name (Legal Business Name): ELENA MARTINHO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ELENA WIECHMANN

II. Dates (important events)

Enumeration Date: 07/29/2005
Last Update Date: 11/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 LAS TABLAS RD STE 0
TEMPLETON CA
93465-9732
US

IV. Provider business mailing address

1111 LAS TABLAS RD STE 0
TEMPLETON CA
93465-9732
US

V. Phone/Fax

Practice location:
  • Phone: 805-434-1511
  • Fax: 805-434-3441
Mailing address:
  • Phone: 805-434-1511
  • Fax: 805-434-3441

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberG65112
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: