Provider Demographics
NPI:1225324692
Name:MARTINEZ, MIGUEL ANGEL (MD)
Entity Type:Individual
Prefix:DR
First Name:MIGUEL
Middle Name:ANGEL
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 1:4007 EVERTS ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92109-5223
Mailing Address - Country:US
Mailing Address - Phone:858-500-2388
Mailing Address - Fax:
Practice Address - Street 1:502 EUCLID AVE STE 304
Practice Address - Street 2:
Practice Address - City:NATIONAL CITY
Practice Address - State:CA
Practice Address - Zip Code:91950-8900
Practice Address - Country:US
Practice Address - Phone:619-477-0084
Practice Address - Fax:619-477-2066
Is Sole Proprietor?:No
Enumeration Date:2011-06-23
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXR1986207P00000X
CAA170161207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXR1985OtherMEDICAL TEXAS LICENSE
FM6647753OtherDEA