Provider Demographics
NPI:1417691825
Name:PARKER, MARTHA BEA
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:BEA
Last Name:PARKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1217 WEDGEWOOD LN
Mailing Address - Street 2:
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786-2958
Mailing Address - Country:US
Mailing Address - Phone:909-568-4676
Mailing Address - Fax:
Practice Address - Street 1:2430 SAN ANTONIO CRES W
Practice Address - Street 2:
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91784-1003
Practice Address - Country:US
Practice Address - Phone:909-568-4676
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-21
Last Update Date:2022-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical