Provider Demographics
NPI:1164551511
Name:MARTIN, JUNE SUSAN (NP)
Entity Type:Individual
Prefix:
First Name:JUNE
Middle Name:SUSAN
Last Name:MARTIN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21013 SHERMAN WAY
Mailing Address - Street 2:UNIT 4
Mailing Address - City:CANOGA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91303-1765
Mailing Address - Country:US
Mailing Address - Phone:818-887-9697
Mailing Address - Fax:818-887-9495
Practice Address - Street 1:21013 SHERMAN WAY
Practice Address - Street 2:UNIT 4
Practice Address - City:CANOGA PARK
Practice Address - State:CA
Practice Address - Zip Code:91303-1765
Practice Address - Country:US
Practice Address - Phone:818-887-9697
Practice Address - Fax:818-887-9495
Is Sole Proprietor?:No
Enumeration Date:2007-03-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA298325363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health