Provider Demographics
NPI:1851174122
Name:MARTIN, SASHA BERNADETTE
Entity Type:Individual
Prefix:
First Name:SASHA
Middle Name:BERNADETTE
Last Name:MARTIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3204 MILLBROOK AVE
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95355-8648
Mailing Address - Country:US
Mailing Address - Phone:408-771-2648
Mailing Address - Fax:
Practice Address - Street 1:3604 CHANT DR
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95355-8482
Practice Address - Country:US
Practice Address - Phone:408-768-4585
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-18
Last Update Date:2023-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider