MEDICARE: KIMETTE MORBY MARTA M.D.

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	207Q00000X	Family Medicine Physician	G066835	CA

General Provider Information

NPI Number	:	1912904228
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMETTE MORBY MARTA M.D.

Provider Business Mailing Address
First Line	:	3400 DATA DR
Second Line	:
City	:	RANCHO CORDOVA
State	:	CA
Zip	:	95670-7956
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3000 Q ST FL 1
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95816-7058
Country	:	US
Telephone Number	:	916-733-3377
Fax Number	:	916-733-5380

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

Provider Enumeration Date	:	06/30/2005
Last Update Date	:	09/18/2023

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