Provider Demographics
NPI:1407806250
Name:SAN LUCIANO PALENZUELA, MARTA (MD)
Entity Type:Individual
Prefix:DR
First Name:MARTA
Middle Name:
Last Name:SAN LUCIANO PALENZUELA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1635 DIVISADERO ST
Mailing Address - Street 2:SUITE 520-530
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94115-3036
Mailing Address - Country:US
Mailing Address - Phone:415-353-2311
Mailing Address - Fax:415-353-9060
Practice Address - Street 1:1635 DIVISADERO ST
Practice Address - Street 2:SUITE 520-530
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94115-3036
Practice Address - Country:US
Practice Address - Phone:415-353-2311
Practice Address - Fax:415-353-9060
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2013-05-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA1190982084N0400X
NY0036002084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology