Provider Demographics
NPI:1346314291
Name:WASIAK, MARTA K (MD)
Entity type:Individual
Prefix:
First Name:MARTA
Middle Name:K
Last Name:WASIAK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 CONCORD AVE
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95928-9487
Mailing Address - Country:US
Mailing Address - Phone:530-879-5000
Mailing Address - Fax:352-351-9495
Practice Address - Street 1:1601 CONCORD AVE
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95928-9487
Practice Address - Country:US
Practice Address - Phone:530-879-5000
Practice Address - Fax:352-351-9495
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2024-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME820062084P0802X, 2084P0804X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0802XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Psychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL53132OtherBCBS FL
FL000745500Medicaid
FL000745500Medicaid
FLBM018YMedicare PIN