Basic Information
| Provider Information | |||||||||
| NPI: | 1770661670 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TAPIA | ||||||||
| FirstName: | MARTHA | ||||||||
| MiddleName: | F. | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1860 HOWE AVE | ||||||||
| Address2: | |||||||||
| City: | SACRAMENTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 958251073 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9164542345 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 3701 J ST | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | SACRAMENTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 958165562 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9164542345 | ||||||||
| FaxNumber: | 9168898099 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/01/2006 | ||||||||
| LastUpdateDate: | 08/12/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 20A7804 | CA | Y | Allopathic & Osteopathic Physicians | Pediatrics | 208000000X | H0058024 | MD | N | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 00AX78040 | 05 | CA | MEDICAID |