Provider Demographics
NPI:1366658403
Name:LILIA MARTINEZ D.D.S. INC.
Entity Type:Organization
Organization Name:LILIA MARTINEZ D.D.S. INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LILI
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:213-484-1500
Mailing Address - Street 1:176 S ALVARADO ST
Mailing Address - Street 2:204
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90057-2218
Mailing Address - Country:US
Mailing Address - Phone:213-484-1500
Mailing Address - Fax:
Practice Address - Street 1:176 S ALVARADO ST
Practice Address - Street 2:204
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90057-2218
Practice Address - Country:US
Practice Address - Phone:213-484-1500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-15
Last Update Date:2015-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA41113261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG93857-01Medicaid