Provider Demographics
NPI:1447426135
Name:TUMAMAK, MARTI NEIL PEREZ
Entity Type:Individual
Prefix:
First Name:MARTI NEIL
Middle Name:PEREZ
Last Name:TUMAMAK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1709 253RD ST
Mailing Address - Street 2:
Mailing Address - City:LOMITA
Mailing Address - State:CA
Mailing Address - Zip Code:90717-1914
Mailing Address - Country:US
Mailing Address - Phone:310-530-7236
Mailing Address - Fax:
Practice Address - Street 1:1709 253RD ST
Practice Address - Street 2:
Practice Address - City:LOMITA
Practice Address - State:CA
Practice Address - Zip Code:90717-1914
Practice Address - Country:US
Practice Address - Phone:310-530-7236
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-02
Last Update Date:2008-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT18028225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist