1922152438 NPI number — MRS. JULIA DEMETRIOUS MARTIN 494412

Table of content: MRS. JULIA DEMETRIOUS MARTIN 494412 (NPI 1922152438)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922152438 NPI number — MRS. JULIA DEMETRIOUS MARTIN 494412

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MARTIN
Provider First Name:
JULIA
Provider Middle Name:
DEMETRIOUS
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
494412
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WEST
Provider Other First Name:
JULIA
Provider Other Middle Name:
DEMETRIOUS
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1922152438
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
15313 RANCHO POLERMO RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PARAMOUNT
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90723-4569
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
562-408-0903
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
550 S VERMONT AVE
Provider Second Line Business Practice Location Address:
11TH FLOOR
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90020-1912
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-639-6777
Provider Business Practice Location Address Fax Number:
213-637-0790
Provider Enumeration Date:
01/22/2007

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: 163WP0808X , with the licence number:  494412 , 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)





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