Individual
DR. GRACE TANDOC MARTIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1165 MONTGOMERY DR, SANTA ROSA, CA 95405-4801
(707) 303-8321
Mailing address
500 DOYLE PARK DR, SUITE 100, SANTA ROSA, CA 95405-4558
(707) 544-6090
(707) 544-2389
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
A83664
CA
208M00000X
Hospitalist Physician
A83664
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GR0061380
—
CA
Enumeration date
08/16/2006
Last updated
09/27/2022
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