Provider Demographics
NPI:1649470758
Name:MULUGETA, MARTHA (NP)
Entity type:Individual
Prefix:
First Name:MARTHA
Middle Name:
Last Name:MULUGETA
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1433 W MERCED AVE
Mailing Address - Street 2:103
Mailing Address - City:WEST COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91790-3402
Mailing Address - Country:US
Mailing Address - Phone:626-337-8000
Mailing Address - Fax:626-337-1145
Practice Address - Street 1:1433 W MERCED AVE
Practice Address - Street 2:103
Practice Address - City:WEST COVINA
Practice Address - State:CA
Practice Address - Zip Code:91790-3402
Practice Address - Country:US
Practice Address - Phone:626-337-8000
Practice Address - Fax:626-337-1145
Is Sole Proprietor?:No
Enumeration Date:2007-07-18
Last Update Date:2016-11-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA9643363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA9643OtherNP LICENSE