Provider Demographics
NPI:1881962793
Name:PRIETO, MARTHA ELENA (PHARMD/MPH)
Entity type:Individual
Prefix:DR
First Name:MARTHA
Middle Name:ELENA
Last Name:PRIETO
Suffix:
Gender:F
Credentials:PHARMD/MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21607 JUAN AVE
Mailing Address - Street 2:
Mailing Address - City:HAWAIIAN GARDENS
Mailing Address - State:CA
Mailing Address - Zip Code:90716-1149
Mailing Address - Country:US
Mailing Address - Phone:562-301-4727
Mailing Address - Fax:
Practice Address - Street 1:11930 STUDEBAKER RD
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:CA
Practice Address - Zip Code:90650-7548
Practice Address - Country:US
Practice Address - Phone:562-864-8138
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-06
Last Update Date:2011-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH66200183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist