Provider Demographics
NPI:1225354871
Name:MARTIN, GINGER ELKINS (LAC)
Entity Type:Individual
Prefix:MRS
First Name:GINGER
Middle Name:ELKINS
Last Name:MARTIN
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1254 TURQUOISE ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92109-1248
Mailing Address - Country:US
Mailing Address - Phone:858-366-8517
Mailing Address - Fax:
Practice Address - Street 1:4683 MERCURY ST
Practice Address - Street 2:SUITE C
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92111-2423
Practice Address - Country:US
Practice Address - Phone:858-467-9893
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-07
Last Update Date:2010-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13465171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist