Provider Demographics
NPI:1598344251
Name:MIGUELENA, MARTA LUCIA (MD)
Entity Type:Individual
Prefix:
First Name:MARTA
Middle Name:LUCIA
Last Name:MIGUELENA
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 1:2674 MAPLEWOOD LN
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARA
Mailing Address - State:CA
Mailing Address - Zip Code:95051-6234
Mailing Address - Country:US
Mailing Address - Phone:408-771-5152
Mailing Address - Fax:
Practice Address - Street 1:455 OCONNOR DR STE 200
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128-1632
Practice Address - Country:US
Practice Address - Phone:408-283-7676
Practice Address - Fax:408-283-7646
Is Sole Proprietor?:No
Enumeration Date:2021-04-07
Last Update Date:2021-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program