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General NPI Number Information
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NPI Number | 1255195921
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Entity Type | Individual
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Provider Name | DANA MARTINO FNP-BC
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Gender | Female
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Dates
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Enumeration Date | 02/12/2024
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Last Update Date | 02/12/2024
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Provider Practice Location Address
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Address Line | 71780 SAN JACINTO DR BLDG I
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City | RANCHO MIRAGE
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State | CA
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Zip | 92270-5516
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Country | US
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Telephone | 516-395-7946
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Fax |
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Provider Business Mailing Address
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Address Line | 680 W 26TH ST
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City | UPLAND
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State | CA
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Zip | 91784-1127
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Country | US
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Telephone |
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Fax |
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 95026073
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License Number State | CA
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