Provider Demographics
NPI:1326287046
Name:MARTINEZ, ERIC A (RPT)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:A
Last Name:MARTINEZ
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23133 HAWTHORNE BLVD
Mailing Address - Street 2:#104
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-3729
Mailing Address - Country:US
Mailing Address - Phone:310-373-3181
Mailing Address - Fax:
Practice Address - Street 1:23133 HAWTHORNE BLVD
Practice Address - Street 2:#104
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-3729
Practice Address - Country:US
Practice Address - Phone:310-373-3181
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-19
Last Update Date:2009-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT17513225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CABN132ZMedicare PIN