MEDICARE: WINNIE ANNE FABROA MARTINEZ

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	183500000X	Pharmacist	60845	CA

General Provider Information

NPI Number	:	1235450859
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WINNIE ANNE FABROA MARTINEZ

Provider Business Mailing Address
First Line	:	8760 19TH STREET
Second Line	:
City	:	RANCHO CUCAMONGA
State	:	CA
Zip	:	91701-9173
Country	:	US
Telephone Number	:	909-989-3235
Fax Number	:	909-481-0327

Provider Business Practice Location Address
First Line	:	8760 19TH STREET
Second Line	:
City	:	RANCHO CUCAMONGA
State	:	CA
Zip	:	91701-9173
Country	:	US
Telephone Number	:	909-989-3235
Fax Number	:	909-481-0327

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

Provider Enumeration Date	:	06/17/2010
Last Update Date	:	06/17/2010

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