Provider Demographics
NPI:1548513914
Name:MOONEY, MARTINA MV (NP)
Entity type:Individual
Prefix:
First Name:MARTINA
Middle Name:MV
Last Name:MOONEY
Suffix:
Gender:F
Credentials:NP
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Mailing Address - Street 1:505 PARNASSUS AVE #M647
Mailing Address - Street 2:UCSF DEPARTMENT OF PEDIATRICS
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94143-2204
Mailing Address - Country:US
Mailing Address - Phone:415-514-0238
Mailing Address - Fax:415-476-9068
Practice Address - Street 1:505 PARNASSUS AVE # M647
Practice Address - Street 2:UCSF DEPARTMENT OF PEDIATRICS
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94143-2204
Practice Address - Country:US
Practice Address - Phone:415-514-0238
Practice Address - Fax:415-476-9068
Is Sole Proprietor?:No
Enumeration Date:2012-10-22
Last Update Date:2012-10-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CA21549363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA21549OtherNURSE PRACTITIONER CERTIFICATION
CA730621OtherREGISTERED NURSE LICENSE