Provider Demographics
NPI:1053503516
Name:CONDON, MARTHA EUGENIA (OTR)
Entity Type:Individual
Prefix:MRS
First Name:MARTHA
Middle Name:EUGENIA
Last Name:CONDON
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1205 SUNGLOW DR
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92056-2528
Mailing Address - Country:US
Mailing Address - Phone:760-726-0623
Mailing Address - Fax:
Practice Address - Street 1:3140 EL CAMINO REAL
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92008
Practice Address - Country:US
Practice Address - Phone:760-720-9898
Practice Address - Fax:760-729-7016
Is Sole Proprietor?:No
Enumeration Date:2007-08-17
Last Update Date:2007-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT 6008174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist