Provider Demographics
NPI:1114251725
Name:MARTIN, LINDA CARRIE (MEDICAL SKIN CARE SP)
Entity Type:Individual
Prefix:MS
First Name:LINDA
Middle Name:CARRIE
Last Name:MARTIN
Suffix:
Gender:F
Credentials:MEDICAL SKIN CARE SP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1350 W 6TH ST
Mailing Address - Street 2:
Mailing Address - City:SAN PEDRO
Mailing Address - State:CA
Mailing Address - Zip Code:90732-3544
Mailing Address - Country:US
Mailing Address - Phone:310-308-1695
Mailing Address - Fax:206-309-9105
Practice Address - Street 1:1350 W 6TH ST
Practice Address - Street 2:
Practice Address - City:SAN PEDRO
Practice Address - State:CA
Practice Address - Zip Code:90732-3544
Practice Address - Country:US
Practice Address - Phone:310-308-1695
Practice Address - Fax:206-309-9105
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-29
Last Update Date:2009-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAZ10168174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist