Provider Demographics
NPI:1053493585
Name:MARTINEZ, LUIS W F (MD)
Entity Type:Individual
Prefix:DR
First Name:LUIS
Middle Name:W F
Last Name:MARTINEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 N 3RD AVE
Mailing Address - Street 2:#301
Mailing Address - City:COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91723-1905
Mailing Address - Country:US
Mailing Address - Phone:626-331-5314
Mailing Address - Fax:626-915-2140
Practice Address - Street 1:315 N 3RD AVE
Practice Address - Street 2:#301
Practice Address - City:COVINA
Practice Address - State:CA
Practice Address - Zip Code:91723-1905
Practice Address - Country:US
Practice Address - Phone:626-331-5314
Practice Address - Fax:626-915-2140
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-20
Last Update Date:2010-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA029395174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA29395Medicare PIN
CAA83946Medicare UPIN