Provider Demographics
NPI:1972779189
Name:CHIODI, MARTINA (MD)
Entity Type:Individual
Prefix:
First Name:MARTINA
Middle Name:
Last Name:CHIODI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24910 LAS BRISAS RD
Mailing Address - Street 2:SUTIE 108
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92562-4010
Mailing Address - Country:US
Mailing Address - Phone:951-461-2229
Mailing Address - Fax:951-461-2771
Practice Address - Street 1:24910 LAS BRISAS RD
Practice Address - Street 2:SUITE 108
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92562-4010
Practice Address - Country:US
Practice Address - Phone:951-461-2229
Practice Address - Fax:951-461-2771
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-07
Last Update Date:2016-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA102206207VG0400X, 207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
No207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
0-595-285-8OtherECFMG