Provider Demographics
NPI:1467541508
Name:RECASENS, MARTA A (M D)
Entity Type:Individual
Prefix:DR
First Name:MARTA
Middle Name:A
Last Name:RECASENS
Suffix:
Gender:F
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1111 N BRAND BLVD
Mailing Address - Street 2:STE 320
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91202-3071
Mailing Address - Country:US
Mailing Address - Phone:818-552-2140
Mailing Address - Fax:818-237-3628
Practice Address - Street 1:1111 N BRAND BLVD STE 320
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91202-3071
Practice Address - Country:US
Practice Address - Phone:818-552-2140
Practice Address - Fax:818-237-3628
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA69115207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A691150Medicaid
CAA69115OtherMEDICAL LIC #
CABR5560506OtherDEA #
CAA69115OtherMEDICAL LIC #
CA00A691150Medicaid
CAWA69115GMedicare ID - Type Unspecified