Provider Demographics
NPI:1710954946
Name:BILL, MARTA BLANDYNA (PA)
Entity Type:Individual
Prefix:MS
First Name:MARTA
Middle Name:BLANDYNA
Last Name:BILL
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:MARTA
Other - Middle Name:BLANDYNA
Other - Last Name:ZAPATA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:8330 RESEDA BLVD
Mailing Address - Street 2:
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91324-4619
Mailing Address - Country:US
Mailing Address - Phone:818-534-1820
Mailing Address - Fax:818-534-1821
Practice Address - Street 1:8330 RESEDA BLVD
Practice Address - Street 2:
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91324-4619
Practice Address - Country:US
Practice Address - Phone:818-534-1820
Practice Address - Fax:818-534-1821
Is Sole Proprietor?:No
Enumeration Date:2006-03-07
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3109363A00000X
363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant