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General NPI Number Information
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NPI Number | 1184135634
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Entity Type | Individual
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Provider Name | MARTIN TATRO
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Gender | Male
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Dates
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Enumeration Date | 10/23/2017
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Last Update Date | 06/28/2024
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Provider Practice Location Address
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Address Line | 212 CARMEN LN
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City | SANTA MARIA
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State | CA
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Zip | 93458-7769
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Country | US
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Telephone | 805-212-7680
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Fax | 805-728-9492
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Provider Business Mailing Address
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Address Line | 212 CARMEN LN
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City | SANTA MARIA
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State | CA
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Zip | 93458-7769
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Country | US
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Telephone | 805-212-7680
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Fax | 805-728-9492
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 167G00000X
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Taxonomy Name | Licensed Psychiatric Technician
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License Number |
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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