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General NPI Number Information
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NPI Number | 1639231384
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Entity Type | Individual
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Provider Name | MARTHA MARION SARASUA MD
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Gender | Female
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Dates
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Enumeration Date | 12/15/2006
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Last Update Date | 04/27/2011
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Provider Practice Location Address
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Address Line | 6706 N 9TH AVE SUITE A4
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City | PENSACOLA
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State | FL
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Zip | 32504-9303
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Country | US
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Telephone | 850-478-2339
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Fax | 850-478-2372
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Provider Business Mailing Address
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Address Line | 6706 N 9TH AVE SUITE A4
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City | PENSACOLA
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State | FL
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Zip | 32504-9303
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Country | US
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Telephone | 850-478-2339
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Fax | 850-478-2372
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | ME0061140
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License Number State | FL
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