Provider Demographics
NPI:1295867414
Name:AQUILEO MARTINEZ D.D.S., INC.
Entity Type:Organization
Organization Name:AQUILEO MARTINEZ D.D.S., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AQUILEO
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTINEZ DE LA CRUZ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:323-261-4838
Mailing Address - Street 1:4521 WHITTIER BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90022-2407
Mailing Address - Country:US
Mailing Address - Phone:323-261-4838
Mailing Address - Fax:323-261-6399
Practice Address - Street 1:4521 WHITTIER BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90022-2407
Practice Address - Country:US
Practice Address - Phone:323-261-4838
Practice Address - Fax:323-261-6399
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SAN LUIS DENTAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-12
Last Update Date:2012-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA423621223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty