Individual
MARTHA HENAO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
555 N 13TH AVE, UPLAND, CA 91786-4904
(909) 277-2420
(909) 206-1097
Mailing address
555 N 13TH AVE, UPLAND, CA 91786-4904
(909) 277-2420
(909) 206-1097
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
A139610
CA
207WX0107X
Retina Specialist (Ophthalmology) Physician
Primary
A139610
CA
Other
Enumeration date
05/16/2014
Last updated
09/21/2022
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