Provider Demographics
NPI:1972293108
Name:FRIAS, MARTHA MICHELLE
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:MICHELLE
Last Name:FRIAS
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 1:1102 SAINT MALO AVE
Mailing Address - Street 2:
Mailing Address - City:LA PUENTE
Mailing Address - State:CA
Mailing Address - Zip Code:91744-1951
Mailing Address - Country:US
Mailing Address - Phone:626-478-4325
Mailing Address - Fax:
Practice Address - Street 1:1102 SAINT MALO AVE
Practice Address - Street 2:
Practice Address - City:LA PUENTE
Practice Address - State:CA
Practice Address - Zip Code:91744-1951
Practice Address - Country:US
Practice Address - Phone:626-478-4325
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-10
Last Update Date:2023-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula