Provider Demographics
NPI:1174511836
Name:CLINE, MARTHA VIRGINIA (NP)
Entity Type:Individual
Prefix:MS
First Name:MARTHA
Middle Name:VIRGINIA
Last Name:CLINE
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 1:33255 9TH ST
Mailing Address - Street 2:
Mailing Address - City:UNION CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94587-2137
Mailing Address - Country:US
Mailing Address - Phone:510-471-5880
Mailing Address - Fax:510-471-9051
Practice Address - Street 1:33255 9TH ST
Practice Address - Street 2:
Practice Address - City:UNION CITY
Practice Address - State:CA
Practice Address - Zip Code:94587-2137
Practice Address - Country:US
Practice Address - Phone:510-471-5880
Practice Address - Fax:510-471-9051
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP14375363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q05020Medicare UPIN