1265738355 NPI number — DR. MARTHA SUSANA NEMER PELLIZA M.D.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265738355 NPI number — DR. MARTHA SUSANA NEMER PELLIZA M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NEMER PELLIZA
Provider First Name:
MARTHA
Provider Middle Name:
SUSANA
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
NEMER
Provider Other First Name:
MARTHA
Provider Other Middle Name:
SUSANA
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1265738355
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/03/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
27309 RUBY GRASS CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MURRIETA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92562-2511
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
951-677-2521
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
25150 HANCOCK AVE
Provider Second Line Business Practice Location Address:
STE 210
Provider Business Practice Location Address City Name:
MURRIETA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92562-5989
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
951-587-3739
Provider Business Practice Location Address Fax Number:
951-698-5213
Provider Enumeration Date:
02/07/2011

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  A97113 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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