Provider Demographics
NPI:1316225246
Name:RICHARD MARTIN, M.D. REHABILITATIVE AND RESTORATIVE MEDICINE INC.
Entity Type:Organization
Organization Name:RICHARD MARTIN, M.D. REHABILITATIVE AND RESTORATIVE MEDICINE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:805-459-2508
Mailing Address - Street 1:880 OAK PARK BLVD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:ARROYO GRANDE
Mailing Address - State:CA
Mailing Address - Zip Code:93420-1821
Mailing Address - Country:US
Mailing Address - Phone:805-459-2508
Mailing Address - Fax:805-473-6516
Practice Address - Street 1:880 OAK PARK BLVD
Practice Address - Street 2:SUITE 202
Practice Address - City:ARROYO GRANDE
Practice Address - State:CA
Practice Address - Zip Code:93420-1821
Practice Address - Country:US
Practice Address - Phone:805-459-2508
Practice Address - Fax:805-473-6516
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-26
Last Update Date:2012-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG83947225400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation PractitionerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG83947Medicare UPIN