Provider Demographics
NPI:1992760714
Name:MARTIN, CAREY MARGARET (NP)
Entity type:Individual
Prefix:
First Name:CAREY
Middle Name:MARGARET
Last Name:MARTIN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1692 EL CAMINO REAL
Mailing Address - Street 2:
Mailing Address - City:SAN CARLOS
Mailing Address - State:CA
Mailing Address - Zip Code:94070-5208
Mailing Address - Country:US
Mailing Address - Phone:650-817-9070
Mailing Address - Fax:650-817-9074
Practice Address - Street 1:1692 EL CAMINO REAL
Practice Address - Street 2:
Practice Address - City:SAN CARLOS
Practice Address - State:CA
Practice Address - Zip Code:94070-5208
Practice Address - Country:US
Practice Address - Phone:650-817-9070
Practice Address - Fax:650-817-9074
Is Sole Proprietor?:No
Enumeration Date:2006-04-18
Last Update Date:2021-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP14485363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
3232OtherSFGH INTERNAL USE ONLY