MEDICARE: MARTHA CARMELLA WILKINS PA-C

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	363AM0700X	Medical Physician Assistant		CA

General Provider Information

NPI Number	:	1215508775
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARTHA CARMELLA WILKINS PA-C

Provider Business Mailing Address
First Line	:	2123 YGNACIO VALLEY RD STE K200
Second Line	:
City	:	WALNUT CREEK
State	:	CA
Zip	:	94598-3336
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2123 YGNACIO VALLEY RD STE 200
Second Line	:
City	:	WALNUT CREEK
State	:	CA
Zip	:	94598-3395
Country	:	US
Telephone Number	:	925-926-0195
Fax Number	:

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

Provider Enumeration Date	:	07/06/2021
Last Update Date	:	09/25/2022

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