Provider Demographics
NPI:1407012537
Name:NAGY, MARTINA (MT)
Entity Type:Individual
Prefix:
First Name:MARTINA
Middle Name:
Last Name:NAGY
Suffix:
Gender:F
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6215 EL CAMINO REAL
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92009-1604
Mailing Address - Country:US
Mailing Address - Phone:731-213-0031
Mailing Address - Fax:
Practice Address - Street 1:6215 EL CAMINO REAL
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92011
Practice Address - Country:US
Practice Address - Phone:731-213-0031
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-29
Last Update Date:2008-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA7609312100174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist