Provider Demographics
NPI:1558976787
Name:MARTENS, BRANDON ERIC
Entity Type:Individual
Prefix:
First Name:BRANDON
Middle Name:ERIC
Last Name:MARTENS
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 1:422 E 7TH ST APT B
Mailing Address - Street 2:
Mailing Address - City:SAN JACINTO
Mailing Address - State:CA
Mailing Address - Zip Code:92583-4861
Mailing Address - Country:US
Mailing Address - Phone:626-394-2769
Mailing Address - Fax:
Practice Address - Street 1:422 E 7TH ST APT B
Practice Address - Street 2:
Practice Address - City:SAN JACINTO
Practice Address - State:CA
Practice Address - Zip Code:92583-4861
Practice Address - Country:US
Practice Address - Phone:626-394-2769
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-14
Last Update Date:2020-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA63480225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist