1184692923 NPI number — DAVID G MARTIN-REAY MD

Table of content: DAVID G MARTIN-REAY MD (NPI 1184692923)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184692923 NPI number — DAVID G MARTIN-REAY MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MARTIN-REAY
Provider First Name:
DAVID
Provider Middle Name:
G
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1184692923
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/02/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9301 OAKDALE AVE
Provider Second Line Business Mailing Address:
SUITE 300
Provider Business Mailing Address City Name:
CHATSWORTH
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91311-6595
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
818-718-9500
Provider Business Mailing Address Fax Number:
818-718-9507

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
PUEBLO AT BATH STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SANTA BARBARA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93105
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-569-7367
Provider Business Practice Location Address Fax Number:
805-569-8354
Provider Enumeration Date:
03/09/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207ZP0102X , with the licence number:  M8817 , registered in the state of ID ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 806618300 , issued by the state of ( ID ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000010143418 . This is a "REGENCE BLUE SHIELD ID" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".
  • Identifier: 1184692923 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 54577 . This is a "BLUE CROSS OF ID" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".




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