Provider Demographics
NPI:1518357474
Name:MARTINEZ, CAMILO (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:CAMILO
Middle Name:
Last Name:MARTINEZ
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:360 SAN MIGUEL DR
Mailing Address - Street 2:SUITE 105
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-7853
Mailing Address - Country:US
Mailing Address - Phone:949-717-0072
Mailing Address - Fax:949-791-3221
Practice Address - Street 1:300 CORPORATE POINTE STE 465
Practice Address - Street 2:
Practice Address - City:CULVER CITY
Practice Address - State:CA
Practice Address - Zip Code:90230-8706
Practice Address - Country:US
Practice Address - Phone:323-203-0070
Practice Address - Fax:310-561-1902
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-30
Last Update Date:2021-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA61729207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine