Provider Demographics
NPI:1699035154
Name:MARTIN, MARGARITA ISABEL (LVN)
Entity Type:Individual
Prefix:
First Name:MARGARITA
Middle Name:ISABEL
Last Name:MARTIN
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3245 W EUCLID AVE
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95204-1336
Mailing Address - Country:US
Mailing Address - Phone:916-420-8849
Mailing Address - Fax:
Practice Address - Street 1:3245 W EUCLID AVE
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95204-1336
Practice Address - Country:US
Practice Address - Phone:916-420-8849
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-17
Last Update Date:2012-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN167654164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse