Provider Demographics
NPI:1407829583
Name:MADRID, MARTHA (MD)
Entity Type:Individual
Prefix:MS
First Name:MARTHA
Middle Name:
Last Name:MADRID
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:PO BOX 2029
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93303
Mailing Address - Country:US
Mailing Address - Phone:661-335-7755
Mailing Address - Fax:661-335-7766
Practice Address - Street 1:4101 EMPIRE DR
Practice Address - Street 2:STE 130
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93309
Practice Address - Country:US
Practice Address - Phone:661-325-1900
Practice Address - Fax:661-325-1960
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG75760207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G757600Medicaid
CA00G757600Medicaid
CA00G757602Medicare ID - Type Unspecified