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General NPI Number Information
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NPI Number | 1649932922
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Entity Type | Individual
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Provider Name | MARIA SUSANA MARTINEZ
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Gender | Female
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Dates
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Enumeration Date | 10/13/2021
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Last Update Date | 10/13/2021
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Provider Practice Location Address
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Address Line | 629 HAMPTON RD
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City | HAYWARD
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State | CA
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Zip | 94541-1417
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Country | US
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Telephone | 510-921-2234
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Fax |
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Provider Business Mailing Address
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Address Line | 18540 MADISON AVE
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City | CASTRO VALLEY
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State | CA
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Zip | 94546-1640
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Country | US
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Telephone | 510-921-2234
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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 | 376G00000X
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Taxonomy Name | Nursing Home Administrator
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License Number | 019200327
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License Number State | CA
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