1700924909 NPI number — DR. MARCO A MARTINEZ M.D.

Table of content: DR. MARCO A MARTINEZ M.D. (NPI 1700924909)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700924909 NPI number — DR. MARCO A MARTINEZ M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MARTINEZ
Provider First Name:
MARCO
Provider Middle Name:
A
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1700924909
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/04/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4566 FLORENCE AVE
Provider Second Line Business Mailing Address:
SUITE # 5
Provider Business Mailing Address City Name:
CUDAHY
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90201-4345
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
323-771-7466
Provider Business Mailing Address Fax Number:
323-771-4920

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4566 FLORENCE AVE
Provider Second Line Business Practice Location Address:
SUITE # 5
Provider Business Practice Location Address City Name:
CUDAHY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90201-4345
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-771-7466
Provider Business Practice Location Address Fax Number:
323-771-4920
Provider Enumeration Date:
02/01/2007

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: 207RN0300X , with the licence number:  A54076 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 00A540761 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com