Provider Demographics
NPI:1609636372
Name:COLE J MARTA MD INC
Entity Type:Organization
Organization Name:COLE J MARTA MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:COLE
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-815-1237
Mailing Address - Street 1:522 N LARCHMONT BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90004-1306
Mailing Address - Country:US
Mailing Address - Phone:213-444-5309
Mailing Address - Fax:213-608-0121
Practice Address - Street 1:522 N LARCHMONT BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90004-1306
Practice Address - Country:US
Practice Address - Phone:213-444-5309
Practice Address - Fax:213-608-0121
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-20
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health