Provider Demographics
NPI:1659538221
Name:NEUMAN, MARIETTA (FNP-BC)
Entity Type:Individual
Prefix:
First Name:MARIETTA
Middle Name:
Last Name:NEUMAN
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:650 COLUMBIA ST
Mailing Address - Street 2:UNIT 110
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92101-6758
Mailing Address - Country:US
Mailing Address - Phone:619-241-2003
Mailing Address - Fax:
Practice Address - Street 1:650 COLUMBIA ST
Practice Address - Street 2:UNIT 110
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92101-6758
Practice Address - Country:US
Practice Address - Phone:619-241-2003
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-20
Last Update Date:2009-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP8343363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily