MEDICARE: MS. MARGIE MARTIN MFT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	MFC29416	CA

General Provider Information

NPI Number	:	1093884009
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARGIE MARTIN MFT

Provider Business Mailing Address
First Line	:	5252 BALBOA AVE
Second Line	:	SUITE 707
City	:	SAN DIEGO
State	:	CA
Zip	:	92117-6906
Country	:	US
Telephone Number	:	858-336-1710
Fax Number	:	888-505-0963

Provider Business Practice Location Address
First Line	:	5252 BALBOA AVE
Second Line	:	SUITE 707
City	:	SAN DIEGO
State	:	CA
Zip	:	92117-6906
Country	:	US
Telephone Number	:	858-336-1710
Fax Number	:	888-505-0963

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/06/2006
Last Update Date	:	08/12/2011

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