Basic Information
Provider Information
NPI: 1205076361
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MARTORANA
FirstName: ELIZABETH
MiddleName: BARG
NamePrefix:  
NameSuffix:  
Credential: PA-C
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
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OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1141 PEAR TREE LN STE 100
Address2:  
City: NAPA
State: CA
PostalCode: 945586485
CountryCode: US
TelephoneNumber:  
FaxNumber:  
Practice Location
Address1: 1141 PEAR TREE LN
Address2:  
City: NAPA
State: CA
PostalCode: 945583673
CountryCode: US
TelephoneNumber: 7072541774
FaxNumber: 7072512993
Other Information
ProviderEnumerationDate: 03/03/2009
LastUpdateDate: 11/15/2019
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363AM0700XPA19200CAY Physician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical

No ID Information.


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