=====================================================
General NPI Number Information
=====================================================
NPI Number | 1700106705
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RAQUELLE MARTINS D.C.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/02/2010
-----------------------------------------------------
Last Update Date | 01/26/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 20995 REDWOOD RD
-----------------------------------------------------
City | CASTRO VALLEY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94546-5919
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 510-727-0660
-----------------------------------------------------
Fax | 510-727-1880
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 20995 REDWOOD RD
-----------------------------------------------------
City | CASTRO VALLEY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94546-5919
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 510-727-0660
-----------------------------------------------------
Fax | 510-727-1880
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | DC-31536
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------