Provider Demographics
NPI:1023182425
Name:MARTIN-SAHIM, DENISE L (AUD)
Entity Type:Individual
Prefix:DR
First Name:DENISE
Middle Name:L
Last Name:MARTIN-SAHIM
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 PENNSYLVANIA AVE STE B
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94533-3510
Mailing Address - Country:US
Mailing Address - Phone:707-426-4327
Mailing Address - Fax:707-426-5190
Practice Address - Street 1:1700 PENNSYLVANIA AVE STE B
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94533-3510
Practice Address - Country:US
Practice Address - Phone:707-426-4327
Practice Address - Fax:707-426-5190
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2022-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA680233061174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHA0023830Medicaid
CAHA0023830Medicaid
CAZZZ16823ZMedicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER