Provider Demographics
NPI:1285034231
Name:PEARSON, MARTHA ANGELINA (MFTI)
Entity Type:Individual
Prefix:MRS
First Name:MARTHA
Middle Name:ANGELINA
Last Name:PEARSON
Suffix:
Gender:F
Credentials:MFTI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4427 HORSESHOE CIR
Mailing Address - Street 2:
Mailing Address - City:ANTIOCH
Mailing Address - State:CA
Mailing Address - Zip Code:94531-8136
Mailing Address - Country:US
Mailing Address - Phone:925-457-1404
Mailing Address - Fax:
Practice Address - Street 1:1470 CIVIC CT
Practice Address - Street 2:SUITE 200
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94520-5290
Practice Address - Country:US
Practice Address - Phone:925-457-1404
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-27
Last Update Date:2016-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF80935390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAIMF80935OtherMEDICAL