Provider Demographics
NPI:1063115608
Name:MARTINEZ-SIMON, JOANNA (PA-C)
Entity type:Individual
Prefix:
First Name:JOANNA
Middle Name:
Last Name:MARTINEZ-SIMON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7200 S LAND PARK DR STE 100
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95831-3669
Mailing Address - Country:US
Mailing Address - Phone:916-422-9110
Mailing Address - Fax:
Practice Address - Street 1:7200 S LAND PARK DR STE 100
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95831-3669
Practice Address - Country:US
Practice Address - Phone:916-422-9110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-23
Last Update Date:2024-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA62746363A00000X
363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant