Provider Demographics
NPI:1578671194
Name:JORGE A. MARTINEZ, MD, INC.
Entity Type:Organization
Organization Name:JORGE A. MARTINEZ, MD, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-461-1331
Mailing Address - Street 1:39755 MURRIETA HOT SPRINGS RD
Mailing Address - Street 2:E120
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92563-9101
Mailing Address - Country:US
Mailing Address - Phone:951-461-1331
Mailing Address - Fax:
Practice Address - Street 1:39755 MURRIETA HOT SPRINGS RD
Practice Address - Street 2:E120
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92563-9101
Practice Address - Country:US
Practice Address - Phone:951-461-1331
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA49113174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA=========OtherEIN