Basic Information
| Provider Information | |||||||||
| NPI: | 1447647300 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MARTINEZ | ||||||||
| FirstName: | PATRICIA | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 325 DISTEL CIR | ||||||||
| Address2: | |||||||||
| City: | LOS ALTOS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 940221408 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5102048090 | ||||||||
| FaxNumber: | 5105067726 | ||||||||
| Practice Location | |||||||||
| Address1: | 2970 HILLTOP ROAD | ||||||||
| Address2: | |||||||||
| City: | RICHMOND | ||||||||
| State: | CA | ||||||||
| PostalCode: | 948065274 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5102048090 | ||||||||
| FaxNumber: | 5105067726 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/18/2015 | ||||||||
| LastUpdateDate: | 11/07/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/03/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | MD60749512 | WA | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | A178696 | CA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | A178696 | 01 | CA | STATE MEDICAL LICENSE | OTHER |